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Dr.Niranjan Murthy H.

L
Asst. Professor,
Dept. of Physiology,
SSMC, Tumkur
Importance of PFT

• Information about functional impairment

• Degree of impairment

• Prognosis of the disease

• Evaluation of treatment
Classification of PFTs
I. Tests to assess ventilatory function:
1. Elastic Properties
a) Lung volume
i) Spirometry
ii) Body Plethysmography
iii) Gas Dilution
b) Elastic Resistance of Lungs
c) Elastic Resistance of Chest Wall
d) Elastic Resistance of Lung + Chest Wall
2. Airway Function
a) Airway Resistance
b) Forced Vital Capacity
c) Maximum Voluntary Ventilation
d) Post bronchodilator Studies
e) Airway Provocation
3. Respiratory Muscle Function
II. Tests to assess blood & gas
distribution and of gas exchange:
1. Intrapulmonary Gas Distribution
a) Multiple-Breath Dilution Techniques
b) Single-Breath Dilution Techniques
c) Frequency Dependence of Compliance
2. Pulmonary Blood Flow Distribution
3. Diffusion
a) Steady-State CO Diffusing Capacity
b) Single-Breath CO Diffusing Capacity
c) Pulmonary Capillary Blood
4. Assessment of Gas Exchange
a) Blood & Gas Sampling & Analysis
b) Calculation of Parameters of Gas
Exchange
i) O2 Consumption
ii) CO2 Production
iii) Respiratory Quotient
iv) Physiologic Dead Space
5. Acid-Base Status
6. Response to Exercise
7. Chemical Regulation of Respiration
Assessment of ventilation
1. ELASTIC PROPERTIES OF LUNG:
b) Lung volumes & capacities-
 Measured using (i) Spirometer,
(ii) Plethysmograph, (iii) Gas dilution
techniques
Spirogram
Lung Volumes:
• Tidal Volume
• Inspiratory Reserve Volume
• Expiratory Reserve Volume
• Residual Volume
Lung Capacities:
• Inspiratory Capacity
• Functional Residual Capacity
• Vital Capacity
• Total Lung Capacity
Body Plethysmography:
• Based on Boyle’s Law
• P1 x TGV = (P1 + ΔPm) (TGV + ΔVp) where
P1- initial pressure
ΔPm- mouth or airway pressure
ΔVp- volume in box
TGV- Thoracic Gas Volume
Gas Dilution:
Insoluble gases like helium, hydrogen or nitrogen
is used.
FRC, RV and TLC can be measured.
iv) Multiple breath Helium Technique
FRC = (VS + VDS) (FIHE – FEHE)
FEHE
Where VS- initial vol of gas in spirometer
VDS- dead space of the system
FIHE- initial He concentration
FEHE- He conc at equilibrium
ii) Single-Breath Helium Technique
TLC x FEHE = (VC x FIHE) + (RV x FOHE)
Where TLC- total lung capacity
VC- vital capacity
RV- residual volume
FEHE- He conc at equilibrium
FIHE- initial He concentration
FOHE- He conc in lungs at onset of
inspiration
iii) Multiple-Breath N2 washout
Closed circuit 100% O2 breathing for 7mins
iv) Single-Breath N2 Clearance

80
N2 conc (%)

30

20
CV RV TLC
10 30%
VC

0
1 2 3 4 5 6
Volume (L)
RV
Vital Capacity
b) Elastic Resistance of lung
i) Transpulmonary Pressure
ii) Airflow & Volume- using
pneumotachogram and spirometer
iii) Compliance of lung- Static & Dynamic

c) Elastic Resistance of total pulm system
• Relaxation Pressure-Volume Curve

d) Elastic Resistance of Chest Wall
1/CT = 1/CL + 1/CCW
2. AIRWAY FUNCTION:
b) Airway Resistance
Measured using plethysmograph
Raw = ΔPm/ ΔV
b) Forced Vital Capacity
Slow inhalation to TLC and fast & hard
exhalation to RV (6 sec)
FEV1- 85%; FEV2- 93%; FEV3- 98 to 100%
c) Maximum Voluntary Ventilation
Breathe hard and fast for 12secs & multiply
by 5.
d) Postbronchodilator Studies
When spirometry and other tests show
airflow limitation
e) Airway Provocation
To check airway hyper-responsiveness
Histamine, Methacholine, Cold air, Exercise,
Occupational irritants
Aspirin, Tartrazine, Sodium salicylate, etc
3. Respiratory Muscle Function
• Mechanical work of breathing: pressure-
volume loop
• Metabolic work of breathing: by
measuring increment of O2 consumption
with increment in minute ventilation
• Efficiency of respiratory system
Mechanical work/Metabolic work

f) Respiratory muscle strength
MEP/MIP, Pdimax, Sniff test
ASSESSMENT OF BLOOD & GAS
DISTRIBUTION AND OF GAS EXCHANGE
1. Intrapulmonary gas distribution:
a) Multiple Breath Dilution Techniques
i) mixing efficiency for helium
ii) nitrogen washout
b) Single-Breath Dilution Techniques
i) regional distribution- xenon133- scintillation
camera
ii) single-breath nitrogen test
c) Frequency Dependence of Compliance
2. Pulmonary Blood Flow Distribution:
Dye dilution principle
 Fick Principle
 Radioactive iodine labeled albumin
 Radioactive Xenon
3. Diffusion:
a) Steady state CO diffusing capacity
b) Single-breath CO diffusing capacity
4. Assessment of gas exchange:
b) Blood & gas sampling and analysis
Arterial blood sampling- Radial or brachial
arteries
 Gas analysis- by using electrodes-
reported at body temperature
 Oxygen electrode- silver anode &
platinum wire cathode- oxygen is
reduced when voltage is applied-
electrons pass from cathode to anode-
measured by galvanometer
 pH and CO2 electrodes
5. Calculation of parameters of gas
exchange:
b) Oxygen consumption
c) CO2 production
d) Respiratory Quotient
e) Physiologic dead space

6. Acid Base Status

7. Response to exercise
Interpretation of PFT
Interpretation of ventilatory function tests:
• Lung volume compartments differ with
age, gender, race and height
• Lung volume and capacity measurements
give an idea about restrictive & obstructive
disorders.
• Reduced FRC, RV & TLC volume-
pressure curve shifted to right &
downwards reduced compliance of lung
and/or chest wall
• Increased FRC, RV & TLC
overdistension volume-pressure curve
shifted to left and upwards obstructive
airway disease

• Normal FRC + increased RV + reduced
TLC mixed disorder

• Vital capacity is used as surrogate to TLC
• Low FEV1 & normal FEV1/FVC ratio
suggest restrictive disorder
• Low FEV1 & low FEV1/FVC suggest
obstructive disorder
Flow rate l/sec 8

RESTRICTIVE
PATTERN

0

6 5 4 3 2 1 0
IC ERV RV

8

OBSTRUCTIVE
PATTERN

0
6 5 4 3 2 1 0 Lung volume (L)
• FEF25-75 and FEV1 may be normal in
increased peripheral airway resistance.

• Closing volume and closing capacity are
rarely used clinically

• On using bronchodilator, FEV1/FEF25-75
must improve by atleast 15% to tell
obstruction is reversible

• Reduced PImax/Pdimax/PEmax may also
suggest poor effort by the subject
Interpretation of blood gases and gas
exchange:
• Respiratory quotient of <0.65 and >0.95
indicate hypo- and hyperventilation
respectively
• P(A-a)O2 is <15mm Hg normally
• Low PaO2 with increased P(A-a)O2 with or
without abnormal PaCO2 indicate
abnormality of gas exchange
• VD/VT is 30% in young and 40% in aged.
Greater than this, it indicates dead-space-
like ventilation.
• Venous admixture like perfusion- low
VA/Q- physiologic shunt
• True venous admixture- PaO2 fails to raise
above 500 mm Hg on breathing 100%
oxygen
• Low DLCO is seen in diffuse pulmonary
fibrosis, pneumonectomy, end-stage
emphysema
• Acid-Base balance: blood pH of 7.35-7.45,
bicarbonate level of 20-27 mEq and PaCO2
between 40-45 mm Hg at sea level.
Respiratory alveolar ventilation COPD High PaCO2.
acidosis Low pH.
Anaesthetics, Narcotics. Normal or high
Mopathies, HCO3-.
Neuropathies.
Kyphoscoliosis,
Obesity.

Respiratory alveolar ventilation Salicylates, Low Pa CO2.
alkalosis progesterone. High pH.
Excessive mechanical Normal or low
ventilation. HCO3-
Psychogenic, fever

Metabolic Gain of H+ or loss of Diabetic ketoacidosis, Low HCO3-.
acidosis HCO3- by ECF starvation Low pH.
Primary lactic acidosis Normal or high
ARF, CRF, RTA PaCO2..
Diarrhoea

Metabolic Gain of HCO3- or loss of Antacid ingestion High HCO3-.
alkalosis H+ by ECF Vomiting, gastric High pH.
suction Normal or high
Diuretics, steroid PaCO2.
therapy