RET 2414 Mod 2 0 BS pirometry by B1d9cb3O

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									Spirometry and Related Tests


  RET 2414
  Pulmonary Function Testing
SPIROMETRY AND RELATED TESTS

   Learning Objectives

       Determine whether spirometry is
        acceptable and reproducible

       Identify airway obstruction using forced
        vital capacity (FVC) and forced expiratory
        volume (FEV1)

       Differentiate between obstruction and
        restriction as causes of reduced vital
        capacity
SPIROMETRY AND RELATED TESTS

   Learning Objectives

       Distinguish between large and small
        airway obstruction by evaluating flow-
        volume curves

       Determine whether there is a significant
        response to bronchodilators

       Select the appropriate FVC and FEV1 for
        reporting from series of spirometry
        maneuvers
Spirometry: Airway Function Tests
 The word spirometry             VC: Volume
 means “the measuring of
 breath.” It is the most
 common of the
 Pulmonary Function
 Tests (PFTs).

  It measures lung            FVC: Volume & Flow
 function, specifically the
 direct measurement of
 the amount (volume)
 and/or speed (flow) of air
 that can be inhaled and
 exhaled.
Spirometry: Airway Function Tests
     Vital Capacity (VC)

     Forced Vital Capacity

     Flow Volume Loop

        Pre/Post Bronchodilator
        Pre/Post Bronchochallenge
Spirometry: Airway Function Tests
     Maximum Voluntary Ventilation (MVV)

     Maximal Inspiratory (MIP)

     Expiratory Pressure (MEP)

     Airway Resistance (Raw)

     Compliance (CL)
    Indications for Spirometry
   Detect the presence of lung disease

Spirometry is recommended as the
“Gold Standard” for diagnosis of
obstructive lung disease by:

     National   Lung Health Education Program
     (NLHEP)

     National   Heart, Lung and Blood Institute
     (NHLBI)

     World   Health Organization (WHO)
Indications for Spirometry BOX 1-2
   Diagnose the presence or absence of lung
    disease

   Quantify the extent of known disease on
    lung function

   Measure the effects of occupational or
    environmental exposure
Indications for Spirometry BOX 1-2
   Determine beneficial or negative effects of
    therapy

   Assess risk for surgical procedures

   Evaluate disability or impairment

   Epidemiologic or clinical research involving
    lung health or disease
SPIROMETRY

   Vital Capacity

    The vital capacity (VC) is the volume
    of gas measured from a slow,
    complete expiration after a maximal
    inspiration, without a forced effort.
SPIROMETRY

   Vital Capacity
SPIROMETRY

   Vital Capacity

       Valid VC measurements important
          IC and ERV used to calculate

           RV and TLC

         Example:
              RV = FRC - ERV
              TLC = IC + FRC
SPIROMETRY

   VC: Criteria for Acceptability
    1.   End-expiratory volume varies by less than 100 ml for
         three preceding breaths

    2.   Volume plateau observed at maximal inspiration and
         expiration
SPIROMETRY

   VC: Criteria for Acceptability
    3.   Three acceptable VC maneuvers should be obtained;
         volume within 150 ml.


    4.   VC should be within 150 ml of FVC value
SPIROMETRY

   VC: Selection Criteria
    The largest single value from at least 3
    acceptable maneuvers should be reported
SPIROMETRY

   VC: Significance/Pathophysiology
       Decreased VC
         Loss of distensible lung tissue
              Lung CA
              Pulmonary edema
              Pneumonia
              Pulmonary vascular congestion
              Surgical removal of lung tissue
              Tissue loss
              Space-occupying lesions
              Changes in lung tissue
SPIROMETRY

   VC: Significance/Pathophysiology
       Decreased VC
         Obstructive lung disease

         Respiratory depression or
          neuromuscular disease
         Pleural effusion

         Pneumothorax

         Hiatal hernia

         Enlarged heart
SPIROMETRY

   VC: Significance/Pathophysiology
       Decreased VC
         Limited movement of diaphragm
               Pregnancy
               Abdominal fluids
               Tumors


           Limitation of chest wall movement
               Scleraderma
               Kyphoscoliosis
               Pain
Predicted Values

   Laboratory Normal Ranges

       Laboratory tests performed on a large
        number of normal population will show
        a range of results
Predicted Values

   Laboratory Normal Ranges
Predicted Values

   Laboratory Normal Ranges

       Most clinical laboratories consider
        two standard deviations from the
        mean as the normal range since it
        includes 95% of the normal
        population.
PFT Reports
o   When performing PFT’s three values
    are reported:

    o   Actual – what the patient performed

    o   Predicted – what the patient should
        have performed based on Age, Height,
        Sex, Weight, and Ethnicity

    o   % Predicted – a comparison of the
        actual value to the predicted value
PFT Reports

   Example

     Actual   Predicted   %Predicted

VC     4.0       5.0        80%
SPIROMETRY

   VC: Significance/Pathophysiology
       If the VC is less than 80% of
        predicted: FVC can reveal if caused by
        obstruction
SPIROMETRY

   VC: Significance/Pathophysiology
       If the VC is less than 80% of
        predicted: Lung volume testing can
        reveal if caused by restriction
SPIROMETRY

   Forced Vital Capacity (FVC)

     The maximum volume of gas that
     can be expired when the patient
     exhales as forcefully and rapidly as
     possible after maximal inspiration
     (sitting or standing)
SPIROMETRY

   FVC (should be within 150 ml of VC)
SPIROMETRY
    FVC: Criteria for Acceptability
1.   Maximal effort; no cough or glottic closure
     during the first second; no leaks or obstruction
     of the mouthpiece.
2.   Good start-of-test; back extrapolated volume
     <5% of FVC or 150 ml, whichever is greater
SPIROMETRY

    FVC: Criteria for Acceptability
3.   Tracing shows 6 seconds of exhalation or an
     obvious plateau (<0.025L for ≥1s); no early
     termination or cutoff; or subject cannot or
     should not continue to exhale
SPIROMETRY

    FVC: Criteria for Acceptability
4.   Three acceptable spirograms obtained; two
     largest FVC values within 150 ml; two largest
     FEV1 values within 150 ml
SPIROMETRY

   FVC: Selection Criteria
    The largest FVC and largest FEV1 (BTPS)
    should be reported, even if they do not
    come from the same curve
SPIROMETRY

   FVC: When to call it quits !!!

    If reproducible values cannot be
    obtained after eight attempts, testing
    may be discontinued
SPIROMETRY

   FVC: Significance and Pathophysiology

       FVC equals VC in healthy individuals

       FVC is often lower in patients with
        obstructive disease
SPIROMETRY

   FVC: Significance and Pathophysiology

       FVC can be reduced by:
           Mucus plugging
           Bronchiolar narrowing
           Chronic or acute asthma
           Bronchiectasis
           Cystic fibrosis
           Trachea or mainstem bronchi obstruction
SPIROMETRY

   FVC: Significance and Pathophysiology

       Healthy adults can exhale their FVC
        within 4 – 6 seconds

       Patients with severe obstruction (e.g.,
        emphysema) may require 20 seconds,
        however, exhalation times >15
        seconds will rarely change clinical
        decisions
SPIROMETRY

   FVC: Significance and Pathophysiology

       FVC is also decreased in restrictive
        lung disease
           Pulmonary fibrosis
               dusts/toxins/drugs/radiation
           Congestion of pulmonary blood flow
               pneumonia/pulmonary hypertension/PE
           Space occupying lesions
               tumors/pleural effusion
SPIROMETRY

   FVC: Significance and Pathophysiology

       FVC is also decreased in restrictive
        lung disease
           Neuromuscular disorders, e.g,
               myasthenia gravis, Guillain-Barre
           Chest deformities, e.g,
               scoliosis/kyphoscoliosis
           Obesity or pregnancy
SPIROMETRY

   Forced Expiratory Volume (FEV1)
      The volume expired over the first
      second of an FVC maneuver
SPIROMETRY
   Forced Expiratory Volume (FEV1)

       FEV1 is the most widely used
        spirometric parameter, particularly
        for assessment of airway
        obstruction
SPIROMETRY
   Forced Expiratory Volume (FEV1)

       FEV1 is used in conjunction with
        FVC for:
           Simple screening
           Response to bronchodilator therapy
           Response to bronchoprovocation
           Detection of exercise-induced
            bronchospasm
SPIROMETRY
   Forced Expiratory Volume (FEV1)
       May be reduced in obstructive or
        restrictive patterns, or poor patient
        effort
SPIROMETRY
   Forced Expiratory Volume (FEV1)

       In obstructive disease, FEV1 may be
        decreased because of:
           Airway narrowing during forced expiration
                emphysema
           Mucus secretions
           Bronchospasm
           Inflammation (asthma/bronchitis)
           Large airway obstruction
                tumors/foreign bodies
SPIROMETRY
   Forced Expiratory Volume (FEV1)

       The ability to work or function in
        daily life is related to the FEV1 and
        FVC
            Patients with markedly reduced FEV1
             values are more likely to die from COPD or
             lung cancer
SPIROMETRY
   Forced Expiratory Volume (FEV1)

       FEV1 may be reduced in restrictive
        lung processes
           Fibrosis
           Space-occupying lesions
           Neuromuscular diseases
           Obesity
           Chest wall deformity
SPIROMETRY
   Forced Expiratory Volume Ratio (FEVT%)

       FEVT% = FEVT/FVC x 100

           Useful in distinguishing between
            obstructive and restrictive causes of
            reduced FEV1 values
SPIROMETRY
   Forced Expiratory Volume Ratio (FEVT%)

       Normal FEVT% Ratios for Health Adults

            FEV 0.5% = 50%-60%
            FEV 1%   = 75%-85%
            FEV 2%   = 90%-95%
            FEV 3%   = 95%-98%
            FEV 6%   = 98%-100%

       Patients with obstructive disease have
        reduced FEVT% for each interval
SPIROMETRY
   Forced Expiratory Volume Ratio (FEVT%)

       A decrease FEV1/FVC ratio is the
        “hallmark” of obstructive disease

         FEV1/FVC   <75%
SPIROMETRY
   Forced Expiratory Volume Ratio (FEVT%)

       Patients with restrictive disease often have
        normal or increased FEVT% values

            FEV1 and FVC are usually reduced in equal
             proportions

       The presence of a restrictive disorder may
        by suggested by a reduced FVC and a
        normal or increased FEV1/FVC ration
SPIROMETRY
   Forced Expiratory Flow 25% - 75%
    (maximum mid-expiratory flow)

       FEF 25%-75% is measured from a
        segment of the FVC that includes flow
        from medium and small airways

            Normal values: 4 – 5 L/sec
SPIROMETRY
   Forced Expiratory Flow 25% - 75%

    In the presence of a borderline
    value for FEV1/FVC, a low FEF
    25%-75% may help confirm
    airway obstruction
SPIROMETRY
   Flow – Volume Curve
       AKA: Flow–Volume Loop (FVL)

        The maximum expiratory flow-
        volume (MEFV) curve shows flow
        as the patient exhales from
        maximal inspiration (TLC) to
        maximal expiration (RV)

       FVC followed by FIVC
SPIROMETRY

    FVL
                                                   FEF 25% or Vmax 75



       X axis: Volume
                                                             FEF 75% or Vmax 25%


       Y axis: Flow

            PEF (Peak Expiratory Flow)

            PIF (Peak Inspiratory Flow)
             .

            Vmax 75 or FEF 25%
         FVC Remaining or Percentage FVC exhaled
             .

            Vmax 50 or FEF 50%
             .

            Vmax 25 or FEF 75%
SPIROMETRY

   FVL
       FEVT and FEF% can be read from
        the timing marks (ticks) on the FVL
SPIROMETRY

   FVL
       Significant decreases in flow or volume
        are easily detected from a single graphic
        display
SPIROMETRY

   FVL: Severe Obstruction
SPIROMETRY

   FVL: Bronchodilation
SPIROMETRY
   Peak Expiratory Flow (PEF)
       The maximum flow obtained
        during a FVC maneuver
         Measured from a FVL
         In laboratory, must perform a
          minimum of 3 PEF maneuvers
         Largest 2 of 3 must be within 0.67
          L/S (40 L/min)
         Primarily measures large airway
          function
         Many portable devices available
SPIROMETRY

   Peak Expiratory Flow (PEF)
       When used to monitor asthmatics
           Establish best PEF over a 2-3 week
            period

           Should be measured twice daily
            (morning and evening)

           Daily measurements are compared to
            personal best
SPIROMETRY
   Peak Expiratory Flow (PEF)
       The National Asthma Education Program
        suggests a zone system
            Green: 80%-100% of personal best
                Routine treatment can be continued; consider
                 reducing medications

            Yellow: 50%-80% of personal best
                Acute exacerbation may be present
                Temporary increase in medication may be
                 needed
                Maintenance therapy may need increases


            Red: Less than 50% of personal best
                Bronchodilators should be taken immediately;
                 begin oral steroids; clinician should be
                 notified if PEF fails to return to yellow or
                 green within 2 – 4 hours
SPIROMETRY
   Peak Expiratory Flow (PEF)
       PEF is a recognized means of
        monitoring asthma

       Provides serial measurements
        of PEF as a guide to treatment

       ATS Recommended Ranges
          60-400 L/min (children)

          100-850 L/min (adults)
SPIROMETRY

   Maximum Voluntary Ventilation
    (MVV)

    The volume of air exhaled in a
    specific interval during rapid, forced
    breathing
SPIROMETRY

   MVV
       Rapid, deep breathing
       VT ~50% of VC
       For 12-15 seconds
SPIROMETRY

   MVV
       Tests overall function of
        respiratory system

           Airway resistance

           Respiratory muscles

           Compliance of lungs/chest wall

           Ventilatory control mechanisms
SPIROMETRY

   MVV
       At least 2 acceptable maneuvers should be
        performed

       Two largest should be within 10% of each
        other

       Volumes extrapolated out to 60 seconds
        and corrected to BTPS

       MVV is approximately equal to 35 time the
        FEV1
SPIROMETRY

   MVV
       Selection Criteria

           The highest MVV (L/min, BTPS) and MVV
            rate (breaths / min) should be reported
SPIROMETRY

   MVV
    Decreased in:

       Patients with moderate to severe
        obstructive lung disease

       Patients who are weak or have decreased
        endurance

       Patients with neurological deficits
SPIROMETRY

   MVV
    Decreased in:

       Patients with paralysis or nerve damage

       A markedly reduced MVV correlates with
        postoperative risk for patients having
        abdominal or thoracic surgery
SPIROMETRY

   Before/After Bronchodilator

       Spirometry is performed before
        and after bronchodilator
        administration to determine the
        reversibility of airway obstruction
SPIROMETRY

   Before/After Bronchodilator

       An FEV1% less than predicted is a
        good indication for bronchodilator
        study

       In most patients, an FEV1% less
        than 70% indicates obstruction
SPIROMETRY

   Before/After Bronchodilator

       Any pulmonary function parameter
        may be measured before and after
        bronchodilator therapy

       FEV1 and specific airway
        conductance (SGaw) are usually
        evaluated
SPIROMETRY

   Before/After Bronchodilator

       Lung volumes should be recorded
        before bronchodilator
        administration

           Lung volumes and DLco may also
            respond to bronchodilator therapy
SPIROMETRY

   Before/After Bronchodilator
       Routine bronchodilator therapy should be
        withheld prior to spirometry
            Ruppel 9th edition, pg. 66: Table 2-2

            Short-acting β-agonists                4 hours
            Short-acting anticholinergic            4 hours
            Long-acting β-agonists                 12 hours
            Long-acting anticholinergic            24 hours
            Methylxanthines (theophyllines)        12 hours
            Slow release methylxanthines           24 hours
            Cromolyn sodium                        8-12 hours
            Leukotriene modifiers                  24 hours
            Inhaled steroids                  Maintain dosage
SPIROMETRY
   Before/After Bronchodilator

       Minimum of 10 minutes, up to 15
        minutes, between administration
        and repeat testing is recommended
        (30 minutes for short-acting
        anticholinergic agents)

       FEV1, FVC, FEF25%-75%, PEF,
        SGaw are commonly made before
        and after bronchodilator
        administration
SPIROMETRY

   Before/After Bronchodilator

       Percentage of change is calculated

    %Change = Postdrug – Predrug X 100
                Predrug
SPIROMETRY

   Before/After Bronchodilator
       FEV1 is the most commonly used
        test for quantifying bronchodilator
        response

       FEV1% should not be used to judge
        bronchodilation response

       SGaw may show a marked increase
        after bronchodilator therapy
SPIROMETRY

   Before/After Bronchodilator
    Significance and Pathophysiology

       Considered significant if:
           FEV1 or FVC increase ≥12% and ≥200 ml

           SGaw increases 30% - 40%
SPIROMETRY

   Before/After Bronchodilator
    Significance and Pathophysiology

       Diseases involving the bronchial
        (and bronchiolar) smooth muscle
        usually improve most from “before”
        to “after”
           Increase >50% in FEV1 may occur in
            patients with asthma
SPIROMETRY

   Before/After Bronchodilator
    Significance and Pathophysiology

       Patients with chronic obstructive
        diseases may show little
        improvement in flows
           Inadequate drug deposition (poor
            inspiratory effort)
           Patient may respond to different drug
           Paradoxical response <8% or 150 ml not
            significant
SPIROMETRY & Related Tests
   Maximal Inspiratory Pressure (MIP)

       The lowest pressure developed
        during a forceful inspiration against
        an occluded airway
            Primarily measures inspiratory muscle
             strength
SPIROMETRY & Related Tests

   MIP
       Usually measured at maximal
        expiration (residual volume)

       Can be measured at FRC

       Recorded as a negative number in
        cm H20 or mm Hg, e.g. (-60 cm H2O)
SPIROMETRY & Related Tests

   MIP
SPIROMETRY & Related Tests

   MIP
    Significance and Pathophysiology

       Healthy adults > -60 cm H2O
       Decreased in patients with:

           Neuromuscular disease

           Diseases involving the diaphragm,
            intercostal, or accessory muscles

           Hyperinflation (emphysema)
SPIROMETRY & Related Tests

   MIP
    Significance and Pathophysiology

       Sometimes used to measure
        response to respiratory muscle
        training

       Often used in the assessment of
        respiratory muscle function in
        patients who need ventilatory
        support
SPIROMETRY & Related Tests
   Maximal Expiratory Pressure (MEP)

       The highest pressure developed
        during a forceful exhalation against
        an occluded airway
            Dependent upon function of the
             abdominal muscles, accessory muscles
             of expiration, and elastic recoil of lung
             and thorax
SPIROMETRY & Related Tests

   MEP
       Usually measured at maximal
        inspiration (total lung capacity)

       Can be measured at FRC

       Recorded as a positive number in
        cm H20 or mm Hg
SPIROMETRY & Related Tests

   MIP and MEP
SPIROMETRY & Related Tests

   MEP
    Significance and Pathophysiology

       Healthy adults >80 to 100 cm H2O
       Decreased in:
           Neuromuscular disorders

           High cervical spine fractures

           Damage to nerves controlling
            abdominal and accessory muscles of
            expiration
SPIROMETRY & Related Tests

   MEP
    Significance and Pathophysiology

       A low MEP is associated with
        inability to cough
           May complicate chronic bronchitis, cystic
            fibrosis, and other diseases that result in
            excessive mucus production
SPIROMETRY & Related Tests

   Airway Resistance (Raw)

       The drive pressure required to
        create a flow of air through a
        subject’s airway

       Recorded in cm H2O/L/sec

       When related to lung volume at the
        time of measurement it is known as
        specific airway resistance (SRaw)
SPIROMETRY & Related Tests

   Raw

       Measured in a
        plethysmograph
        as the patient
        breathes
        through a
        pneumo-
        tachometer
SPIROMETRY & Related Tests

   Raw
       Criteria of Acceptability
          Mean of three or more acceptable
           efforts should be reported;
           individual values should be within
           10% of mean
SPIROMETRY & Related Tests

   Airway Resistance (Raw)

      Normal Adult Values

    Raw   0.6 – 2.4 cm H2O/L/sec

    SRaw 0.190 – 0.667 cm H2O/L/sec/L
SPIROMETRY & Related Tests

   Airway Resistance (Raw)

       May be increased in:

           Bronchospasm
           Inflammation
           Mucus secretion
           Airway collapse
           Lesions obstructing the larger airways
                Tumors, traumatic injuries, foreign bodies
SPIROMETRY & Related Tests

   Raw
    Significance and Pathology
       Increased in acute asthmatic episodes

       Increased in advanced emphysema because of
        airway narrowing and collapse

       Other obstructive disease, e.g., bronchitis may
        cause increase in Raw proportionate to the
        degree of obstruction in medium and small
        airways
SPIROMETRY & Related Tests

   Airway Conductance (Gaw)

       A measure of flow that is generated
        from the available drive pressure

       Recorded in L/sec/cm H2O

       Gaw is the inverse of Raw

       When related to lung volume at the
        time of measurement it is known as
        specific airway conductance (SGaw)
SPIROMETRY & Related Tests

   Gaw

       Measured in a
        plethysmograph
        as the patient
        breathes
        through a
        pneumo-
        tachometer
SPIROMETRY & Related Tests

   Gaw
       Criteria of Acceptability
          Mean of three or more acceptable
           efforts should be reported;
           individual values should be within
           10% of mean
SPIROMETRY & Related Tests

   Airway Conductance (Gaw)

      Normal Adult Values

    Gaw   0.42 – 1.67 L/sec/cmH2O

    SGaw 0.15 – 0.20 L/sec/cm H2O/L
SPIROMETRY & Related Tests

   Airway Conductance (Gaw)

      Significance and Pathology

       SGaw Values <0.15 – 0.20
       L/sec/cm H2O/L are consistent
       with airway obstruction
Quiz Practice
  Most clinical laboratories consider
  two standard deviations from the
  mean as the normal range when
  determining predicted values since it
  includes 95% of the normal
  population.
  a.   False
  b.   Only for those individuals with lung
       disease
  c.   This applies only to cigarette smokers
  d.   True
Quiz Practice
  Vital capacity is defined as which of
  the following?
  a.   The volume of gas measured from a slow,
       complete exhalation after a maximal
       inspiration, without a forced effort
  b.   The volume of gas measured from a rapid,
       complete exhalation after a rapid maximal
       inspiration
  c.   The volume of gas measured after 3 seconds of
       a slow, complete exhalation
  d.   The total volume of gas within the lungs after a
       maximal inhalation
Quiz Practice
       Which of the following statements are
       true regarding the acceptability criteria
       for vital capacity measurement?
            I.     End-expiratory volume varies by less than 100
                   ml for three preceding breaths
            II.    Volume plateau observed at maximal inspiration
                   and expiration
            III.   Three acceptable vital capacity maneuvers
                   should be obtained; volume within 150 ml
            IV.    Vital capacity should be within 150 ml of forced
                   vital capacity in healthy individuals
  a.     I, II, and IV
  b.     II, III, and IV
  c.     III and IV
  d.     I, II, III, IV
Quiz Practice
       Which of the following best
       describes the Forced Vital Capacity
       (FVC) maneuver?
  a.     The volume of gas measured from a slow,
        complete exhalation after a maximal
        inspiration, without a forced effort
  b.    The volume of gas measured from a slow,
        complete exhalation after a rapid maximal
        inspiration
  c.    The volume of gas measured after 3 seconds
        of a rapid, complete exhalation
  d.    The maximum volume of gas that can be
        expired when the patient exhales as forcefully
        and rapidly as possible after maximal
        inspiration
Quiz Practice
       All of the following are true
       regarding the acceptability
       criteria of an FVC maneuver
       EXCEPT?
  a.    Maximal effort, no cough or glottic
        closure during the first second; no leaks
        of obstruction of the mouthpiece
  b.    Good start of test; back extrapolated
        volume less than 5% of the FVC or 150 ml
  c.    Tracing shows a minimum of 3 seconds of
        exhalation
  d.    Three acceptable spirograms obtained;
        two largest FVC values within 150 ml; two
        largest FEV1 values within 150 ml
Quiz Practice
       The FEV1 is the expired volume of
       the first second of the FVC
       maneuver.
  a.    True
  b.    False
  c.    Only when done slowly
  d.    Only when divided by the FVC
Quiz Practice
       Which of following statements is
       true regarding FEV1?
  a.    FEV1 may be larger than the FVC
  b.    FEV1 is always 75% of FVC
  c.    May be reduced in obstructive and
        restrictive lung disease
  d.    Is only reduced in restrictive disease
Quiz Practice
       The FEV1% is useful in
       distinguishing between obstructive
       and restrictive causes of reduced
       FEV1 values
  a.    True
  b.    False
  c.    Only helps to distinguish obstructive
        lung disease
  d.    Only helps to distinguish restrictive
        lung disease
Quiz Practice
     Which statements are true
     regarding the FEV 1%, also known
     as the FEV1/FVC?
           I.     A decreased FEV1/FVC is the hallmark of
                  obstructive disease
           II.    Patients with restrictive lung disease often
                  have normal or increased FEV1/FVC ratios
           III.   The presence of a restrictive disorder may
                  be suggested by a reduced FVC and a
                  normal or increased FEV1/FVC ratio
           IV.    A normal FEV1/FVC ratio is between 75%
                  - 85%
a.   I and II
b.   I, II and III
c.   II, III and IV
d.   I, II, III and IV
Quiz Practice
       What test is
       represented by the
       graph to the right?
  a.    Forced Vital Capacity
  b.    Flow-Volume Loop
  c.    Slow Vital Capacity
  d.    Total Lung Capacity
        Maneuver
Quiz Practice
         What type of pulmonary disorder is
         represented by the graph below?
    a.    Obstructive lung disease
    b.    Restrictive lung disease
    c.    Upper airway obstruction
    d.    Normal lung function

(The dotted lines represent the predicted values)
Quiz Practice
     Which is true regarding Peak
     Expiratory Flow (PEF)?
            I.     Primarily measures large airway function
            II.    Is a recognized means of monitoring
                   asthma
            III.   Serial measurements of PEF are used a
                   guide to treat asthma
            IV.    When less than 50% of personal best, it is
                   an indication that immediate treatment is
                   required
a.   I only
b.   II and III
c.   II, III, and IV
d.   I, II, III, and IV
Quiz Practice
     MVV is decreased in patients with
     which of the following disorders?
           I.     Moderate to severe obstructive lung
                  disease
           II.    Weak or with decrease endurance
           III.   Neurological defects
           IV.    Paralysis or nerve damage
a.   I and IV
b.   II and III
c.   III and IV
d.   I, II, III, and IV
Quiz Practice
       Spirometry before and after
       bronchodilator therapy is used to
       determine which of the following?
  a.    Reversibility of airway obstruction
  b.    The severity of restrictive disorders
  c.    The rate at which CO diffuses through the lung
        into the blood
  d.    If the patient has exercised induced asthma
Quiz Practice
       What is the minimum amount of
       time between administration of
       bronchodilator therapy and repeat
       pulmonary function testing?
  a.    5 minutes
  b.    10 minutes
  c.    30 minutes
  d.    60 minute
Quiz Practice
       Bronchodilation is considered
       significant when which of the
       following occurs?
  a.    FEV1/FVC increases by 12%
  b.    SGaw increases by 12%
  c.    FVC and/or FEV1 increases by 12% and 200 ml
  d.    DLco increases by 12%
Quiz Practice
     Which of the following is true
     regarding Maximal Inspiratory
     Pressure (MIP)?
           I.     Primarily measures inspiratory muscle
                  strength
           II.    Measures airway resistance during
                  inspiration
           III.   Is decreased in patients with neurological
                  disease
           IV.    Often used in the assessment of
                  respiratory muscle function in patients
                  who need ventilatory support
a.   I, II, and III
b.   I, III, and IV
c.   II and III
d.   II, III, and IV
Quiz Practice
       Airway resistance (Raw) is the
       drive pressure required to create a
       flow of air through a subject’s
       airway.
  a.    True
  b.    False
  c.    Only in patients with COPD
  d.    Only in patients with restrictive
        disorders
Quiz Practice
     Airway resistance may be
     increased in which of the following
     patients?
           I.     Purely restrictive lung disorders
           II.    Acute asthmatic episodes
           III.   Mucus secretion
           IV.    Lung compliance changes
a.   I only
b.   I and IV
c.   II and III
d.   I, II, III, and IV
Quiz Practice
       Airway Conductance (Gaw) is a
       measure of flow that is generated
       from the available drive pressure.
  a.    True
  b.    False
  c.    Only in patients with COPD
  d.    Only in patients with restrictive
        disorders
Quiz Practice
     A patient’s pulmonary function
     tests reveal the following:

              Actual       Predicted   %Predicted
    FVC      4.01 L       4.97 L            81
    FEV1     2.58 L       3.67 L            56
    FEV1% 51              >75               _

Select the correct interpretation
a.   Restrictive pattern
b.   Obstructive pattern
c.   Inconclusive
d.   Normal
Quiz Practice
    A patient’s pulmonary function tests reveal
    the following:

             Actual       Predicted   %Predicted
   FVC       3.75 L       4.97 L           75
   FEV1      2.80 L       3.67 L           76
   FEV1%     75           >/=75             _


Select the correct interpretation
a.  Restrictive pattern
b.  Obstructive pattern
c.  Inconclusive
d.  Normal

								
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