pulmonary function testing by: gh. pouryaghoub. md center for research on occupational diseases...
TRANSCRIPT
![Page 1: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/1.jpg)
PULMONARY FUNCTION TESTING
By: Gh. Pouryaghoub. MDCenter for Research on Occupational Diseases (CROD)Tehran University of Medical Sciences (TUMS)
![Page 2: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/2.jpg)
PULMONARY FUNCTION TESTS CATEGORIES
Spirometry
Lung volumes (TLC/ RV )
Diffusing capacity tests
Blood gases and gas exchange tests
Cardiopulmonary exercise tests
Metabolic measurements
![Page 3: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/3.jpg)
INDICATIONS FOR SPIROMETRY
Detect the presence or absence of lung disease
Quantify the extent of known disease
Determine effects of therapy
Asses risk of surgical procedures
Measure effect of Occup. Or Env. Exposure
Evaluate disability or impairment
![Page 4: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/4.jpg)
Contraindications
Ascending aortic aneurysm
Pulmonary embolism
Myocardial infarction (1m)
Angina
Hemoptysis
severe HTN (systolic > 200, diastolic > 120)
Pneumothorax
Cerebral, thoracic or abdominal aneurysm
Recent brain, eye or ear surgery
Thoracic or abdominal surgery(3 w)
Acute diarrhea
Infection control issue
![Page 5: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/5.jpg)
Confounding factors
Smoking within 1 h of testingConsuming alcohol within 4 h of testingVigorous exercise within 30 min of testingTight clothingLarge meal within 2 h of testingChest or abdominal painPain in mouth or faceStress incontinenceDementia or confessional state
![Page 6: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/6.jpg)
Complications
Chest pain
Syncope, dizziness
Increased ICP
Paroxysmal coughing
Bronchospasm
Nosocomial infection
![Page 7: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/7.jpg)
Hygiene & infection control
Hand washing
Gloves
Disposable mouth piece & nose clip
Disinfection or sterilization of reusable mouth piece
Extra precautions for patient with infection
![Page 8: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/8.jpg)
Respiratory Volumes
Tidal Volume: Amount of air moved in and out of lungs during normal breathing
Inspiratory Reserve Volume: Amount of air inspired over normal tidal inspiration at maximal effort
Expiratory Reserve Volume: Amount of air expired over normal tidal expiration at maximal effort
Residual Volume: Air left in lung after maximal expiration
![Page 9: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/9.jpg)
Respiratory Capacities
Functional Residual Capacity: ERV+RV
Inspiratory Capacity: TV+IRV
Vital Capacity: IRV+TV+ERV
Total Lung Capacity: VC+RV
![Page 10: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/10.jpg)
LUNG VOLUMES & CAPACITIES
![Page 11: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/11.jpg)
Type of spirometer
Volumetric spirometer
Flow-type spirometer
![Page 12: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/12.jpg)
Flow – Volume Curve
![Page 13: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/13.jpg)
Volume - Time Curve
![Page 14: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/14.jpg)
Spirometric values
FVC (forced vital capacity)
FEV1 (forced expiratory volume in 1 s)
FEV1/FVC
FEF25-75 (maximum midexpiratory flow)
FEVt (forced expiratory volume in t s)
PEF (peak expiratory flow)
![Page 15: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/15.jpg)
Spirometry Steps
Equipment performance criteria
Equipment validation
Subject maneuvers
Acceptability
Repeatability
interpretation
![Page 16: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/16.jpg)
Technical Sources of Variation in Lung Function
Instrument (Precision and Accuracy)
Effort
Posture (body and head position)
Observer
Procedure (including number of tests)
Software (calculation and feedback)
Temperature
Altitude
![Page 17: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/17.jpg)
Biologic Sources of Variation in Lung Function
Diurnal variation
Seasonal effects
Endocrinologic effects
Personal factors
Environmental factors
Occupation factors
![Page 18: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/18.jpg)
Within Maneuver Acceptability Criteria
Extrapolated volume
Cough especially during first second
End of test criteria
Valsalva maneuver (glottis closure)
Leak from the mouth
Obstruction of the mouthpiece
Extra breath during the maneuver
![Page 19: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/19.jpg)
![Page 20: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/20.jpg)
![Page 21: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/21.jpg)
Between Maneuver Acceptability Criteria
Three acceptable spirograms
Two largest FVC within 0.150 L of each other
Two largest FEV1 within 0.150 L of each other
A total of eight tests
or
The patient cannot or should not continue
![Page 22: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/22.jpg)
![Page 23: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/23.jpg)
Are these results below the “lower limit of normal?”
![Page 24: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/24.jpg)
Interpretation
Predicted value & lower limit of normal (LLN)
Fifth percentile: the point below which 5% of normal subjects fall.
FEV1 and FVC = 80%FEV1/FVC = 70-75%FEF25-75 = 50-60%
![Page 25: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/25.jpg)
LLN for male with 175cm height
Age FVC FEV1 FEV1/FVC FEF25-75
20 83% 83% 74% 68%
40 82% 81% 70% 60%
60 80% 78% 66% 46%
80 76% 72% 62% 18%
![Page 26: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/26.jpg)
Normal Spirometry
Both the FVC and the FEV1/VC ratio are normal.
![Page 27: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/27.jpg)
Obstructive Spirometry
Normal or low FVC, Low FEV1 & FEV1/FVC
![Page 28: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/28.jpg)
Restrictive Spirometry
Low FVC & FEV1, Normal or high FEV1/FVC (TLC & RV should be measured)
![Page 29: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/29.jpg)
Mixed pattern Spirometry
Low FEV1, FVC, FEV1/FVC
![Page 30: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/30.jpg)
![Page 31: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/31.jpg)
The Severity of the Abnormality
% Pred FEV1 > 80 Normal
% Pred FEV1 < 80 and > 70 = Mild
% Pred FEV1 < 70 and > 60 = Moderate
% Pred FEV1 < 60 and > 50 = Moderately severe
% Pred FEV1 < 50 and > 35 Severe
% Pred FEV1 < 35 = Very severe
![Page 32: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/32.jpg)
![Page 33: PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)](https://reader035.vdocuments.net/reader035/viewer/2022062519/5697c0231a28abf838cd43dd/html5/thumbnails/33.jpg)