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SPIROMETRY

RESPIRATORY FUNCTION TESTS

PULMONARY FUNCTION TESTS

SPIROMETRY
Measurement of volume and/or flow rate of
air breathed in and/or out of the lungs under
the specific condition of maximal effort,
according to established criteria and
standards
Study of procedure of measurement of
lung volumes and capacities

SPIROMETER

An apparatus used to calculate the lung


volumes and capacities

Divided into two categories

1. Diagnostic spirometers
2. Monitoring spirometers

STUDENT WET SPIROMETER

PARTS OF SPIROMETER

PARTS OF A SPIROMETER

MAIN TANK
THERMOMETER
OPEN FLOAT
COUNTER WEIGHT
SODALIME CONTAINER
VALVE LEVER
CORRUGATED RUBBER TUBE
NOSE CLIP
INK PEN

MAIN TANK
Rectangular metallic tank with a raised
platform
Drain hole in the base
Water level marked on side wall
Platform has three openings i.e. one for
oxygen and two large ones connected to
corrugated tubes for inlet and outlet of air
and gases

THERMOMETER
Attached to side of platform
Records temperature of contents of tank

OPEN FLOAT

Hinged on one side of tank


Has two arms on which weight rests
One side is graduated in liters marked from
0-9 liters

COUNTER WEIGHT
Adjusts the balance and position of the float

SODA LIME CONTAINER


Connected with outer corrugated tube
Absorbs CO2 from expired air

VALVE LEVER
Adjusts corrugated tube connections to
atmosphere and spirometer

T- TUBE
Connects the mouth piece to corrugated
tubes
Its stem is connected to the mouth piece
One limb consisting expiratory valve is
connected to outer tube
Other limb consisting inspiratory valve is
connected to inner tube

CORRUGATED RUBBER TUBE


Two in number
One inner and the other outer at the base of
the tank
Connected to a plate at one end and
connected to limbs of T-tube at the other
end

MOUTH PIECE
Connected to the stem of T-tube

PLAIN RUBBER TUBE

Two in number
Inner tube for filling the oxygen into the float
Outer tube for drainage of water
Lumens of these tubes can be occluded by
adjusting screws

NOSE CLIP
Close the nostrils while breathing through
mouth

INK PEN
Can be filled by ordinary ink
Adjusted on kymograph with writing lever to
write on the graph paper mounted on
revolving drum

PRINCIPLE OF SPIROMETRY

SPIROGRAM
Graphical representation of lung volumes
and capacities using a spirometer

TYPICAL READINGS ON A
SPIROGRAM

SPIROGRAM
(NORMAL VS ABNORMAL)

LUNG VOLUMES AND


CAPACITIES

Tidal volume
Functional residual capacity
Inspiratory capacity
Inspiratory reserve volume
Expiratory reserve volume
Residual volume
Vital capacity
Total lung capacity
Forced expiratory volume in one (first) second

TIDAL VOLUME (VT)


Amount of air that enters OR leaves the
lungs in a single respiratory cycle is called
tidal volume
500 ml

FUCTIONAL RESIDUAL CAPACITY


(FRC)
Volume of air in the lungs at the end of a
passive expiration or with the glottis open
and all respiratory muscles relaxed
Considered to be neutral or equilibrium
point for respiratory system
2700 ml

INSPIRATORY CAPACITY (IC)


Maximal volume of air that can be inspired
from functional residual capacity
4000 ml

INSPIRATORY RESERVE VOLUME


(IRV)
Additional amount of air that can be inhaled
after a normal inspiration
3500 ml

EXPIRATORY RESERVE VOLUME


(ERV)
Amount of air that can be expired after
normal expiration
1500 ml

RESIDUAL VOLUME (RV)


Amount of air in the lungs after a maximal
expiration
1200 ml
N.B: residual volume and any capacity of
lung containing residual volume e.g. TLC
and FRC can not be measured with a
spirometer directly!

VITAL CAPACITY (VC)


Maximal volume of air that can be inspired
after a maximal inspiration
5500 ml

TOTAL LUNG CAPACITY (TLC)


The amount of air in the lungs after a
maximal inspiration
6700 ml

FORCED EXPIRATORY VOLUME


IN ONE/FIRST SECOND (FEV1)
Amount of air expired with force in one
second

MAXIMUM VOLUNTARY
VENTILATION (MVV)
Volume of air exhaled in a specified period
(1minute), during rapid and forced breathing
Also called as maximum breathing capacity
125-170 L/min

AMERICAN ASSOCIATION FOR RESPIRATORY CARE


(AARC)
CLINICAL PRACTICE GUIDELINES
OBJECTIVE OF SPIROMETRY
Assessment of ventilatory function
Includes, though not limited to, measurement of FVC,
FEV1 and other forced expiratory flow measurements
It may also include measurement of MVV
Either a volume-time or flow-volume is acceptable on a
spirogram!
Other parameters that may be obtained by spirometry are
FEF max (PEF), FEF 75%, FEF 50%, FEF 25% and FIF
max (PIF)

DIFFERENT SETTINGS IN WHICH


SPIROMTRY IS USED
For pulmonary function or research labs
On bedside, in acute, subacute or extended
care and skilled nursing facilities
In clinics, treatment facility or physician
office
In workplace or home
For public screening for epidemiological
purposes (occupational hazards)

INDICATIONS
Detection for presence or absence of lung dysfunction
and/or presence of other abnormal diagnostic tests (CXR,
ABGs)
Assessment of severity of known lung disease
Assessment of change in lung function over time or
following administration of, or change of, therapy
Assessment of potential effects or response to environment
or occupational exposure
Assessment of risk for surgical procedures known to affect
lung function
Assessment of impairment or disability (for legal reasons,
rehabilitation, military recruitments etc)

RELATIVE CONTRAINDICATIONS
Hemoptysis (may aggravate!)
Pneumothorax
Unstable cardiovascular status
Thoracic, abdominal or cerebral aneurysm (danger
of rupture of vessels due to increased thoracic
pressure)
Recent ophthalmic, thoracic, cerebral or abdominal
surgery
Presence of acute disease that might interfere with
test performance e.g., nausea & vomiting

HAZARDS
Although spirometry is a very safe process for
assessment of lung function, following have rarely
been observed!

Pneumothorax
Increased intracranial pressure
Dizziness
Chest pain
Contraction of nosocomial infections
Bronchospasm

ACCEPTABILITY CRITERIA

NUMBER OF TRIALS
At least 3 acceptable FVC maneuvers
Good and rapid start
No cough
No early termination of exhalation
A minimum exhalation time of 6 seconds is
recommended

REPRODUCABILITY
2 largest FVCs from acceptable maneuvers
should not vary by more than 200 ml
2 largest FEV1s from acceptable
maneuvers should not vary by more than
200 ml

RELATED TOPICS

Total ventilation
Alveolar ventilation
Increases in depth of breathing
Increases in rate of breathing
Dead spaces
Respiratory zone

TOTAL VENTILATION (VE)


It refers to the minute volume or minute ventilation
Total volume of air moved in or out of lungs per
minute
VE=VT * f
=500 * 15
=7500 ml/minute
(where VT is tidal volume and f is respiratory rate )

ALVEOLAR VENTILATION (VA)


Represents air delivered to respiratory zone per minute
Since first 150 ml of each inspiration comes from anatomic
dead space, it does not contribute to alveolar ventilation
Every additional ml of air however contributes to alveolar
ventilation
VA=(VT-VD) * f
=(500-150) * 15
=350 * 15
=5250 ml/minute
N.B: Alveolar ventilation per inspiration is 350 ml

RESPIRATORY ZONE & DEAD


SPACES

PULMONARY DEAD SPACES


ANATOMIC DEAD SPACE
PHYSIOLOGIC DEAD SPACE
ALVEOLAR DEAD SPACE
RESPIRATORY ZONE

MEASURING LUNG VOLUMES


USING A WET SPIROMETER
At rest:
1. Measure resting heart rate and respiration rate
for each subject.
2. Attach a disposable mouthpiece to the valve.
Clamp the subject's nostrils closed and have the
subject breathe normally to adjust to the
apparatus. DO NOT INHALE from the spirometer ONLY EXHALE into the spirometer.

PROTOCOL
Obtain the following lung volumes for each
subject by carefully following each set of
instructions:
Each group member should measure
resting heart rate and respiration rate and
the resting lung volumes below. Then each
group should choose one set of data to be
entered on the computer/notebook to be
used as class data.

RESTING LUNG VOLUMES


Tidal Volume:
Breathe normally a few times. Inspire
normally and blow a normal exhalation into
the tube. Record this volume as Tidal
Volume.

RESTING LUNG VOLUMES


(continued..)
Inspiratory reserve volume:
Inhale as deeply as possible, then blow into the
mouthpiece until you've emptied what you've
forcefully inspired, but do not forcefully exhale
(return to a normal level of exhalation). This is your
inspiratory capacity (IC) To calculate inspiratory
reserve volume, subtract tidal volume value from
inspiratory capacity value (IRV=IC-TV).
Breathe normally a few times.

RESTING LUNG VOLUMES


(continued..)
Expiratory reserve volume:
After a normal exhalation, exhale as
forcefully and fully as possible into the
mouthpiece. Record this volume as
expiratory reserve volume.
Breathe normally a few times.

RESTING LUNG VOLUMES


(continued..)
Vital Capacity:
Breathe in as deeply as possible, and then
exhale into the mouthpiece as fully as
possible. Record this volume as Vital
Capacity.
Breathe normally a few times.

PEAK FLOW MEASUREMENT


1) Use one hand to hold your paper mouth piece over the
opening of the Peak Flow Meter and use the other hand to
cover the back side opening of the Peak Flow Meter.
2) Inhale as deeply as possible, then blow into the
mouthpiece as fast and as forcefully as you can.
3) Insert the rubber tubing into the paper mouth piece.
Repeat steps 1 and 2 above.
4) Record the flow rate (L/min)

OBSTRUCTIVE
In obstructive lung conditions, the airways are
narrowed, usually causing an increase in the time
it takes to empty the lungs. Obstructive lung
disease can be caused by conditions such as
emphysema, bronchitis, infection (which
produces inflammation), and asthma.

Lung function values in obstructive disease


FEV1 often increases after using medicine that expands the airways in people with reversible obstructive disease like asthma.

Lung function test

Result as predicted for age, height, sex,


weight, or race

Forced vital capacity (FVC)

Normal or lower than predicted value

Forced expiratory volume (FEV1)

Lower

FEV1 divided by FVC

Lower

Forced expiratory flow 25% to 75%

Lower

Peak expiratory flow (PEF)

Lower

Maximum voluntary ventilation (MVV)

Lower

Slow vital capacity (SVC)

Normal or lower

Total lung capacity (TLC) (VT)

Normal or higher

Functional residual capacity (FRC)

Higher

Residual volume (RV)

Higher

Expiratory reserve volume (ERV)

Normal or lower

RV divided by TLC ratio

Higher

RESTRICTIVE
In restrictive lung conditions, there is a loss of lung
tissue, a decrease in the lungs' ability to expand,
or a decrease in the lungs' ability to transfer
oxygen to the blood (or carbon dioxide out of the
blood). Restrictive lung disease can be caused by
conditions such as pneumonia, lung cancer,
scleroderma, pulmonary fibrosis, sarcoidosis, or
multiple sclerosis. Other restrictive conditions
include some chest injuries, being very overweight
(obesity), pregnancy, and loss of lung tissue due to
surgery.

Lung function values in restrictive disease


Lung function test

Result as predicted for age, height, sex, weight, or race

Forced vital capacity (FVC)

Lower than predicted value

Forced expiratory volume (FEV1)

Normal or lower

FEV1 divided by FVC

Normal or higher

Forced expiratory flow 25% to 75%

Normal or lower

Peak expiratory flow (PEF)

Normal or lower

Maximum voluntary ventilation (MVV)

Normal or lower

Slow vital capacity (SVC)

Lower

Total lung capacity (TLC) (VT)

Lower

RV divided by TLC ratio

Normal or higher

Functional residual capacity (FRC)

Normal or lower

Residual volume (RV)

Normal, lower, or higher

Expiratory reserve volume (ERV)

Normal or lower

TABLE 1. Respiratory Diseases and Conditions Commonly Associated With a Restrictive Breathing
Pattern.

CENTRAL NERVOUS SYSTEM AND CHEST


BELLOWS

LUNGS

Polio

Pneumonia

Obesity

Sarcoidosis

Myasthenia gravis

Lung fibrosis

Guillain Barr syndrome

Acute respiratory failure associated with pulmonary


edema

Flail chest (multiple broken ribs)

Hyaline membrane disease

Diaphragm paralysis

Advanced lung cancer

Spinal cord disease

Congestive heart failure

Pickwickian syndrome
Pleural effusion and pleural disease

TABLE 2. Diseases or Conditions That May be Associated With Obstruction to Airflow

Lower Airway Obstruction:

Asthma
Chronic bronchitis

Emphysema

Cystic fibrosis

Sarcoidosis

Upper Airway Obstruction:

Croup
Laryngotracheobronchitis

Epiglottitis
Various tumors and foreign bodies that may involve the
upper airway

BYE

FOR

NOW