W11

PULMONARY FUNCTION TEST

ELIN ELISA
AHPT 2333
22.12.2023 | FRIDAY | 8.30 – 11. 30 a.m.
 BRIEF INTRODUCTION ON PFT
• A non-invasive procedure implemented to evaluate the efficiency and capacities of the lung
• Function: provide clinician with the information about airway’s integrity, function of
respiratory musculature & condition of lung tissues
• Achieve through measurement of lung volume, lung capacities, rate of gas flow & exchange
• Through PFT, pulmonary disease may be classified: obstructive, restrictive or combined
• Diagnostic tool / outcome measure / objective assessment: spirometry & exercise stress test
• Human lung can hold a maximum (lung capacity) ~6 l of air
 SPIROMETRY
• Function:
• Measure and / estimate the amount of air that goes in & out of the lung
• Help maintain / improve respiratory muscle strength following injury / operation /
illness
• Types of spirometry:
• Electronical device: spirometry machine (diagnostic tool)
• Mechanical device: flow oriented (triflo) & volume oriented (incentive spiro)
(interventional tool)
It is a hand-held device which give the patient’s visual
feedback on the volume of inhalation
Triflow Incentive spirometry
C) SPIROMETRY MACHINE

Measurement unit of 4000 ml capacity & has

inhalation flow speed: one-way valve to prevent Measure lung’s
600, 900, 1200 ml/sec exhalation volume & capacities
 LUNG
VOLUMES
AND
CAPACITIES

Spirogram
 LUNG VOLUMES
Volume of gas in the lung at a given time during respiratory cycle

Parameters Description
1. Tidal volume Volume of air inhaled and exhaled during normal respiration /
(VT) relaxed breathing (0.5 l)
2. Inspiratory reserve volume Extra volume of air that can be inhaled with max effort after
(IRV) reaching near normal, quiet inspiration (2.5 l)
3. Expiratory reserve volume Extra volume of air that can be exhale with max effort after
(ERV) reaching near normal, quiet expiration (1.5 l)
4. Residual volume Volume of air remaining in the lung even after maximal expiration
(VR) (1.5 l)
 LUNG CAPACITIES
Summation of different lung volume

Parameters Description
1. Total lung capacity Volume of air the lung contain at the end of maximum inhalation
(TLC) TV + IRV + ERV + RV (6.0 l)
2. Vital capacity Volume of air can be exhale after maximum inhalation or
(VC) Volume of air can be inhale after maximum exhalation
TV + IRV + ERV (4.5 l)
3. Inspiratory capacity Volume of air that can be inspired
(IC) TV + IRV (3.0 l)
4. Functional residual capacity Volume of air reside in the lung after exhalation
(FRC) ERV + RV (3.0 l)
FLOW – VOLUME (F-V) LOOP
• Generated from spirometry machine & must
be compared with predicted value (norm)
• Interpretation:
• Forced expiratory volume in 1 sec (FEV1)
• Vital capacity (VC)
• Forced vital capacity (FVC): max air exhaled
when blowing out as fast as possible
• Force expiratory flow (FEF): F25% - 75% of
FVC
• FEV1 / FVC ratio
• Peak expiratory flow (PEF): maximal flow
of exhalation when blowing out as fast as
possible
• Inspiratory vital capacity (IVC): max air that
can be inhale from the point of max
expiration
OBSTRUCTIVE VS. RESTRICTIVE
 SPIROMETRY INTERPRETATION
Parameters Observed Predicted % Predicted Indicator
FEV1 (l) 2.15 3.83 56 
FVC (l) 4.31 4.44 97 N
FEV1 / FVC (%) 50.00 86.00 58 
FEF25-75% (l/s) 0.93 4.27 22 -
PEFR (l/s) 5.23 8.01 65 -
Normal range: FEV1 = 80 – 120%, FVC = 80 – 120%, FEV1 / FVC =  70%  obstructive pattern is observed

Types FEV1 FVC FEV1 / FVC TLC RV F-V loop shape

Obstructive  N to     Concave shape in expiration
Restrictive   N to    Normal shape; diminished in size
 INDICATIONS FOR SPIROMETRY
(TRIFLO & INCENTIVE SPIRO)
• Pre-op management to prevent • Restrictive and obstructive lung
secondary post-op complication condition
• Presence of pulmonary atelectasis • Patient undergoing coronary artery
• Abdominal & thoracic surgery bypass graft (CABG)
• Prolonged bed rest
• Patient with spinal cord injury or
neuromuscular diseases
 CONTRAINDICATIONS FOR
SPIROMETRY
• Unstable CV status (i.e., uncontrollable BP • Pneumothorax
even with medications) • Hyperventilation ( RR) / severe dyspnoea

• Haemoptysis of the unknown origin • Hypoxemia

(inhalation might aggravate conditions) • Fatigue

• Patient who cannot use the device • Patient in severe pain (immediately post-operative)
appropriately & require max supervision • Patient who are heavily sedated / comatose

• Patient who are non-compliant / do not • Patient generally unwell

understand / demonstrate improper use of the • Chest pain
device (i.e., too young / old / mental problem /
learning disabilities) • Recent eye or abdominal surgery (spiro machine)
PRACTICAL SESSION
TRIFLOW & INCENTIVE SPIRO
SPIROMETRY MACHINE
 PROCEDURES: SPIROMETRY MACHINE
• Check for contraindications & key in patient’s detail inside the machine
• Patient wear comfortable clothing, remove denture (if any) & sit upright on a chair with
arms with feet flat on the floor
• Seal mouthpiece tightly & apply nose clip (hold the nose), elevate the chin and extend neck
slightly
• FVC, FEV1: put in the mouthpiece → breath in & out normally (1-2x) → inhale air as much
as possible while therapist press the FVC button → exhale as hard & fast as
possible → finish the test by inhale as fast & complete as possible → press ESC or wait for
the test terminate automatically
• 3 trials but rest provided 30 s in between procedures (chose the best readings)
 PROCEDURES: TRIFLO & INCENTIVE
SPIRO
• Patient is in ½ lying position / crook lying with pillow supported under the knee
• Patient perform normal breathing, inhalation → exhalation (1x)
• Hold the triflo device in upright position → put in the mouthpiece → patient is instructed to
inhale with a slow and sustained deep breath through mouth → hold (3-5 secs) → exhale
passively (avoid forceful exhalation)
• Try to lift all three ball & noted at which chamber patient able to maintain the ball (600, 900,
1200 ml/sec)
• Same procedure is applied for Incentive spiro. Noted the highest possible volume achieved
• 3 sets; 3 – 5 reps; 3x/day
• Patient should focus on using abdominal breathing (expanding lower ribcage more)
(Amin et al., 2021; Alaparthi et al., 2016)
 DOCUMENTATION & INTERPRETATION
OF SPIROMETRY
• Outcome measure:
Device Result
Triflo _____ ml/sec @ ____ balls up
Incentive S _____ ml

Parameters Result
FEV1 _______ %
FVC _______ %
FEV1/FVC _______ %
 Obstructive / restrictive pattern observed / normal pulmonary function
 TAKE AWAY QUESTIONS
• Differences & similarities triflow (flow-oriented) & incentive spirometry
(volume-oriented)?

• Explain possible reason why prescription of triflow or incentive spirometry

aid in the improvement of pulmonary function & respiratory muscle
strength.
 REFERENCES
Amin, R., Alaparthi, G. K., Samuel, S. R., Bairapareddy, K. C., Raghavan, H., & Vaishali, K.
(2021). Effects of three pulmonary ventilation regimes in patients undergoing coronary
artery bypass graft surgery: a randomized clinical trial. Scientific Reports, 11(1), 6730.
https://doi.org/10.1038/s41598-021-86281-4
Moore, V. C. (2012). Spirometry: step by step. Breathe, 8(3), 232–240.
https://doi.org/10.1183/20734735.0021711
Alaparthi, G. K., Augustine, A. J., Anand, R., & Mahale, A. (2016). Comparison of
Diaphragmatic breathing exercise, volume and flow incentive spirometry, on diaphragm
excursion and pulmonary function in patients undergoing Laparoscopic Surgery: A
Randomized Controlled Trial. Minimally Invasive Surgery, 2016(3), 1–12.
https://doi.org/10.1155/2016/1967532