Spirometry for clinicians by Dr Sarma.ppt

8/10/2019 Spirometry for clinicians by Dr Sarma.ppt

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www.drsarma.in

Visit us at www.drsarma.in

Dr. R.V.S.N.Sarma., M.D., M.Sc.,Consultant Physician & Chest Specialist

E mail: [email protected] 3760 9226 or 2766 0593

93805 21221 or 98940 60593
http://www.drsarma.in/mailto:[email protected]:[email protected]://www.drsarma.in/


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Pulmonary Function Tests

Ventilatory Function Spirometry

Clinical Applications


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LUNG FUNCTION TESTS

Tests of Ventilation

Tests of DiffusionTests of PerfusionTests for V-P Mismatch


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LUNG FUNCTION TESTS

Tests of Ventilation

Tests of DiffusionTests of PerfusionTests for V-P Mismatch


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Function of Ventilation

Air Exit Airways, Bronchomotor tone,Secretions, Thoracic muscles etc

Air Entry Expansion of lungs Functioning lung volume, its elasticnature, Lung compliance

Air Out Problem Obstructive Diseases Air In problem Restrictive DiseasesBoth Air Out and In - Combined


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ObjectivesTo detect Obstructive Airway Diseases

To quantify the severity of obstruction.To assess response to IBD.To identify Restrictive Lung Diseases.

To identify flow-volume loop patternsTo understand the clinical relevance.

Spirometry


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PEAK FLOW METER

Diagnosis of ASTHMA or COPD can beconfirmed by demonstrating the presenceof airway obstruction using Spirometry.


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PEFR - Pros and Cons

AdvantagesWith in 1 to 2 minutes,Inexpensive (meter costs less than Rs.1000)Simple, useful for frequent follow up use

Disadvantages Very much effort dependentInsensitive to small changesSmall airways cannot be assessedLarge inter & intra subject variation; accurate


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SPIROMETRY


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SPIROMETRY


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SPIROMETRY


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SPIROMETRY


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Spirometry - Pros and Cons Advantages

Evaluates smaller as well as larger airwaysRelatively easy to use and maintain

Reversibility can be tested with IBD and steroidsDiagnostic as well as management assessments

DisadvantagesCosts about 50,000 + computer and printerTakes time to perform 10 to 15 minutesRequires training at least one day course


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Spirometry ManeuverIn single breath test

A few normal tidal respirationsThen deeeeep inspirationMomentary breath holding

Very forced and fast expiration As hard and as fast as he/she can blow out

Then deep, quick and full inspirationRepeat at least 3 times take the best


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Reproducibility of Spirometry

Adequate explanation to the patientDemonstrating the steps one by one

Encouraging the patient to give best effortTaking at least 3 and usually 5 attemptsSelecting the best effort

Cough and severe dyspnoea may interfereNot like ECG Results depend on effort


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Normal

Flow-Volume

Volume-Time

Test Values


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Spirometry Results

FVC Forced Vital CapacityFEV1 Forced Expiratory Volume

in the first secondFEV1 /FVC Ratio of the above two

PEFR Peak Expiratory Flow RateFET Forced Expiratory Time


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Spirometry Normal Values1. There are no fixed Normal values 2. Dependent on age, sex, height, weight, ethnicity3. Observed value expressed as % of predicted value

FVC Normal if > 80% of predictedFEV1 Normal if > 80% of predicted

FEV1/FVC At least 75%PEFR Normal if > 80% of predictedFET Less than 4 seconds


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The Four Square Game

F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.

FVC NORMALFVC < 80% Pred.

80%

80%


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80%

80%

Normal LungsFEV 1FCV is N

F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.


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80%

80%

F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.

Obstructive DiseaseFEV 1 FCV is Low


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80%

80%

F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.

Restrictive DiseaseFEV 1 FCV is High


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F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.


80%

80%

Combined Obs+ResFEV 1 FCV is N or L


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F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.


80%

80%






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F E V

1 N O R M A L

F E V 1 < 8 0 %

o f P d

.


80%

80%

Normal AirEntry & Exit

Air Exit Problem Airways choked

Air Entry ProblemLungs expansion

Both Air Entry & Air Exit Problem


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Normal Airways and Lungs

FVC > 80%FEV1 > 80%FEV1 FCV > 75%

PEFR > 80%FET


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Normal Airways - PFT


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Bronchial Asthma Reversible Airway obs.Chronic bronchitis Irreversible with IBD

Emphysema Irreversible with IBDBronchiectasis Airway rigidityCystic Fibrosis

Allergic bronchopulmonary AspergillosisBronchiolitis

Obstructive Airways Disease


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Obstructive Airways Disease

FVC > 80%FEV1 < 80%FEV1 FCV < 75%

PEFR < 80%FET >4 sec

Air Entry Normal Air Exit Problem

FEV1 is LOW

FVC is Normal

FEV1 FVCis < 75%


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Obstructive Airways Disease - PFT

FEV1 is LOW

FVC is Normal

FEV1 FVCis < 75%


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Obstructive V/s Normal


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Obstructive Airways Mild

Bronchial Asthma


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Bronchial Asthma

Reversible Obstruction (IBD)


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Bronchiectasis (Obstructive)

BRONCHOGRAM - BIL UNILATERAL


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Obstructive Airways Severe

Emphysema


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Obstructive Airways Severe -IBD

Emphysema


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Obstructive Lung Diseases

ABPA CYSTIC FIBROSIS


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Upper Airway Obstruction

Truncation of flow loopExpiratory Intra ThoracicInspiratory Extra Thoracic

Both Fixed ObstructionTumourTracheal stenosisTracheal FB

Vocal Chord Dysfunction


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Restrictive Lung Diseases

SarcoidosisTuberculosis (Fibrocaseous)

Interstitial Lung Disease - ILDIdiopathic pulmonary fibrosis - IPFPneumoconiosis

Drug- or radiation-induced lung diseasePneumonectomy


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Extrinsic Restrictive Diseases

Kyphosis, Scoliosis Ankylosing Spondylitis

Massive Pleural effusionPregnancy, Obesity, AscitesRib fractures

Neuromuscular disorders


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Restrictive Lung Disease

FVC < 80%FEV1 > 80%FEV1 FCV > 75%

PEFR > 80%FET


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Restrictive Lung Disease - PFT

FEV1 is LOW

FVC is Normal

FEV1 FVCis < 75%

ILD or IPF


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Restrictive V/s Normal

ILD or IPF


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ILD or IPF

Restrictive Lung Disease - ILD


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HEPATIOD APPEARANCE


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RETICULAR PERIPHERIES


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Restrictive Lung Diseases

SARCOIDOSIS RETICULO-NODULAR


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Combined Obstructive + Restrictive

FVC < 80%FEV1 < 80%FEV1 FCV < 75%

PEFR < 80%FET >4 sec

Air Entry Problem Air Exit Problem

FEV1 is LOW

FVC is Normal

FEV1 FVCis < 75%


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FEV1 is LOW

FVC is Normal

FEV1 FVCis < 75%


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KOCHS + EMPHYSEMA


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Other Patterns

FIXEDOBSTRUCTION


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Other Patterns

EXTRA THORACIC

COUGH


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Case 1

Test Pred. Meas. %

FVC 5.5 L 4.5 L 82%

FEV1 4.9 L 3.0 L 61%Ratio 89% 66% -

Man, aged 28, 172cm, 71kg

Non smoker, Cough 3 M


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Case 1


Non smoker, Cough 3 M

Dx : Bron Asthma - Rev

IBD GoodResponse

Test Pred. Meas. %

FVC 5.5 L 4.5 L 82%

FEV1 4.9 L 3.0 L 61%Ratio 89% 66% -


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Case 2

Woman, 48 y, 155cm, 47 kg

Non smoker, Dysp., CP

Test Pred. Meas. %

FVC 3.9 L 2.6 L 66%

FEV1 3.1 L 2.4 L 78%Ratio 79% 92% -


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Case 2


Non smoker, Dysp., CP

Diagnosis : # Ribs 5,6,7,8

Test Pred. Meas. %

FVC 3.9 L 2.6 L 66%

FEV1 3.1 L 2.4 L 78%Ratio 79% 92% -


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Case 3

Test Pred. Meas. %

FVC 6.0 L 5.0 L 83%

FEV1 4.8 L 4.1 L 85%Ratio 80% 82% -

Man 35, 175cm, 75kg, MC

Non smoker, Clinical N


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Case 4

Child, 8 y, 128 cm, 19 kg

Stridor, Dysp G3, BS Decr.

Test Pred. Meas. %

FVC 1.9 L 0.7 L 36%

FEV1 1.6 L 0.4 L 25%Ratio 84% 57% -


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Case 4

Child, 8 y, 128 cm, 19 kg

Stridor, Dysp G3, BS Decr.

Test Pred. Meas. %

FVC 1.9 L 0.7 L 36%

FEV1 1.6 L 0.4 L 25%Ratio 84% 57% -

FB in the UAW


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Case 5


Had ATT, Dysp G3, Wheeze

Test Pred. Meas. %

FVC 3.5 L 1.8 L 51%

FEV1 2.8 L 1.2 L 43%Ratio 80% 66% -


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Case 5

Diagnosis : TB + ABPA

Test Pred. Meas. %

FVC 3.5 L 1.8 L 51%

FEV1 2.8 L 1.2 L 43%Ratio 80% 66% -


Had ATT, Dysp G3, Wheeze


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Case 6


Smoker 16yr, Severe Dysp.

Test Pred. Meas. %

FVC 4.5 L 3.7 L 82%

FEV1 3.6 L 1.8 L 50%Ratio 80% 49% -


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F E V

1 N O R M A L

F E V

1 < 8 0 %

o f P d .


80%

80%






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Millers Prediction Quadrants

F E V

1 N O R M A L

F E V

1 < 8 0 %

o f P d

.


Air In and Out NNormal LungsFEV 1FCV is N

Air Exit is chockedObstructive Disease

FEV 1 FCV is Low

Air Entry is reducedRestrictive DiseaseFEV 1 FCV is High

Both Air In & OutCombined Obs+Res

FEV 1 FCV is N or L

90% 100%70% 80%60%

90%

100%

70%

60%


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Take Home Points

All that wheezes is not Asthma only

All Dyspnoea does not wheeze

Do not over simplify dyspnoea to Deriphyllin

Etiology of Dyspnoea needs elucidation

Spirometry tests but Ventilation function only

Need to test diffusion, Perfusion functionsCardiac, Hematologic and other causes


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Spirometry for clinicians by Dr Sarma.ppt

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