Ho Hap Ky (Spirometry)

H HP K
(SPIROMETRY)
GII THIU
H hp k l mt trong bn xt nghim
c bn ca thm d CNHH (h hp k,
o tng dung lng phi, kh nng
khuch tn ca phi v kh trong mu).
L tiu chun vng chn on COPD
L dng c dng o cc th tch ht
vo v th ra theo thi gian.
Gi tr lm sng ca HHK ph thuc vo
cht lng my, k thut o, v chn
gi tr d on ph hp.
CC LOI H HP K
My o th tch theo thi gian:

L loi c in c chung p trn mt
thng nc hay dng n xp.
MY HHK O TH TCH
CC LOI H HP K
My o lu lng theo th tch phi

Loi dng b phn nhn cm o
khuynh p t tnh ra lu lng v th
tch phi
MY HHK O LU LNG
MY HHK IN T BN
MY HHK XCH TAY
Cc th tch v dung tch phi
4 th tch: th tch
d tr ht vo, th
tch kh lu thng,
th tch d tr th
ra, v th tch kh
cn
4 dung tch: dung
tch sng, dung tch
ht vo, dung tch
cn chc nng,
dung tch phi ton
b
Cc th tch phi
Th tch kh lu thng
(Tidal Volume- TV): Th
tch kh ca mt ln ht
vo hoc th ra bnh
thng
Th tch d tr ht vo
(Inspiratory Reserve
Volume -IRV): Th tch
kh ht vo thm khi
gng sc, sau khi ht
vo bnh thng
Th tch kh d tr th
ra (Expiratory Reserve
Volume -ERV): Th tch
kh th ra thm c
khi gng sc, sau khi
th ra bnh thng
Cc th tch phi
Th tch kh cn
(Residual Volume
-RV):
Th tch kh vn cn
trong phi sau khi
th ra ti a
c o trc tip
(FRC-ERV) bng
ph thn k (Body
Plethysmography)
hay pha long
helium, khng o
bng spirometry
Cc dung tch phi
Total Lung Capacity

(TLC): Tng cc th
tch trong phi
Vital Capacity (VC): Th
tch ln nht m ngi
ta c th huy ng c
bng cch th ra ht sc
sau khi ht vo ht
sc
Inspiratory Capacity
(IC): Tng ca th tch
d tr ht vo v th
tch kh lu thng
Cc dung tch phi (tt)
Dung tch cn chc

nng (Functional
Residual Capacity FRC):
Tng RV v ERV
hoc th tch kh ca
phi cui th th ra
bnh thng
c o bng ph
thn k (Body
Plethysmography)
hay pha long
helium, khng o
bng spirometry
CC CH S H HP K
FVC (Forced vital capacity):

Th tch kh ton b c th ra gng sc
trong mt ln th
FEV1 (Forced expiratory volume in one

second): Th tch kh th ra trong giy u
T s FEV1/FVC (ch s Gaensler); FEV1/VC

( ch s Tiffeneau):
Phn s kh c th ra trong giy u lin
quan vi th tch kh ton b c th ra
CC CH S H HP K
FEF 25-75% (Forced Expiratory Flow

between 25% and 75% of the FVC)
(L/s):
Lu lng th ra gng sc trong
khong 25 75% ca dung tch
sng gng sc
PEF ( Peak Expiratory Flow)(L/s):

Lu lng th ra nh
CC CH S H HP K (tt)
PIF ( Peak Inspiratory Flow)(L/s):

Lu lng ht vo nh: Lu lng cao nht
trong lc ht vo, thng c dng nh
gi tc nghn ng h hp trn.
MVV ( Maximal Volumtary Ventilation)

(L/pht)
Th tch thng kh t ti a
GIN TH TCH THEO THI GIAN
NG CONG LU LNG TH TCH
KT QU H HP K
Bnh
Tc
Hn
thng
nghn
ch
Dng
hn hp
H HP K
CC GI TR BNH THNG
CC GI TR BNH THNG
C D ON
Ph thuc vo:
Tui
Chiu cao
Gii
Chng tc
CC GI TR BNH THNG
C D ON (tt)
c da trn cc kho st trong dn s

ln
Cc gi tr c d on l cc gi tr
trung bnh ly t kt qu kho st
Khng c cc kho st trong dn s
ngi gi
Tiu chun cho mt h hp k bnh

thng sau dn ph qun
FEV1:
% d on > 80%
FVC:
% d on > 80%
FEV1/FVC:
> 0.7
ng cong lu lng - th tch

v th tch theo thi gian ca mt ngi bnh thng
H HP K
BNH PHI TC NGHN
Tiu chun chn on hi chng tc

nghn trn h hp k
FEV1:%d
FVC:%d
on < 80
on > 80 hoc < 80
FEV1/FVC:<
0.7
ng cong ch s tc nghn
H HP K
BNH PHI HN CH
Tiu chun bnh phi hn ch

FEV1:
% d on > 80 hoc <
80
FVC:
% d on < 80
FEV1/FVC:
> 0.7
ng cong ch s hn ch
RI LON THNG KH HN HP
FEV1:
FVC:
% d on < 80%
% d on < 80%
FEV1 /FVC:
< 0.7
Th tch, lt
ng cong ch ri lon thng kh

kiu hn hp
Bnh thng
Tc nghn + hn
ch
Thi gian, giy
H HP K
NG CONG
LU LNG - TH TCH
NG CONG LU LNG -TH

TCH
chun
cho hu ht cc my h hp
k bn
Cung cp thng tin thm vo ng
cong th tch theo thi gian
Khng qu kh gii thch kt qu
Pht hin tt hn khi c s tc
nghn lung kh nh
Cc dng ng cong lu lng th tch
CH NH
nh gi cc triu chng, cc du hiu bnh

phi
nh gi s tin trin ca bnh phi
Theo di hiu qu iu tr
nh gi nguy c h hp trc phu thut
Gim nh y khoa v sc khe h hp
Tm sot cc i tng c nguy c bnh phi
Theo di tc dng c hi ca mt s thuc,
ha cht
CHNG CH NH
Tnh trng tim mch khng n nh
Nhi mu c tim gn y
Phu thut mt, ngc, bng gn y
Trn kh mng phi
Phnh ng mch ch
Ho ra mu
Cc tnh trng cp tnh nh chng mt,

vim phi
CC BIN CHNG
Ngt, chng mt, nhc u nh
Co tht ph qun
Ho
Gim bo ha oxy nu iu tr oxy
b gin on
p lc ni s tng
Trn kh mng phi
au ngc
Nhim trng
Ht
Spirometry and Related Tests
RET 2414
Pulmonary Function Testing
Module 2.0
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 flowvolume curves
Determine whether there is a significant

response to bronchodilators
Select the appropriate FVC and FEV1 for

reporting from series of spirometry
maneuvers
Predicted Values
Laboratory Normal Ranges

Laboratory
tests performed on a large

number of normal population will show
a range of results
Predicted Values
Predicted Values

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 PFTs three values

are reported:
o
Actual what the patient performed
Predicted what the patient should

have performed based on Age, Height,
Sex, Weight, and Ethnicity
% Predicted a comparison of the

actual value to the predicted value
PFT Reports
Example
VC
Actual
Predicted
%Predicted
4.0
5.0
80%
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 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
Decreased VC
Obstructive lung disease

Respiratory depression or
neuromuscular disease
Pleural effusion
Pneumothorax
Hiatal hernia
Enlarged heart
SPIROMETRY
Decreased VC
Limited movement of diaphragm
Pregnancy
Abdominal fluids
Tumors
Limitation of chest wall movement
Scleraderma
Kyphoscoliosis
Pain
SPIROMETRY
If the VC is less than 80% of

predicted: FVC can reveal if caused by
obstruction
SPIROMETRY
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
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
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 can be reduced by:
Mucus plugging
Bronchiolar narrowing
Chronic or acute asthma
Bronchiectasis
Cystic fibrosis
Trachea or mainstem bronchi obstruction
SPIROMETRY
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 is also decreased in restrictive

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

lung disease
Neuromuscular disorders, e.g,
Chest deformities, e.g,
myasthenia gravis, Guillain-Barre

scoliosis/kyphoscoliosis
Obesity or pregnancy
SPIROMETRY
Forced Expiratory Volume (FEV1)

The volume expired over the first
second of an FVC maneuver
SPIROMETRY
May be reduced in obstructive or

restrictive patterns, or poor patient
effort
SPIROMETRY
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
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

FEV1
may be reduced in restrictive

lung processes
Fibrosis
Edema
Space-occupying lesions
Neuromuscular diseases
Obesity
Chest wall deformity
SPIROMETRY

FEV1
is the most widely used

spirometric parameter, particularly
for assessment of airway
obstruction
SPIROMETRY

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 Ratio (FEVT%)
FEVT% = FEVT/FVC x 100
Useful in distinguishing between

obstructive and restrictive causes of
reduced FEV1 values
SPIROMETRY
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
A decrease FEV1/FVC ratio is the

hallmark of obstructive disease
FEV1/FVC
<75%
SPIROMETRY
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:
FlowVolume Loop (FVL)
The maximum expiratory flowvolume (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
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%
FEF 75% or Vmax 25%
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

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
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
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
An FEV1% less than predicted is a

good indication for bronchodilator
study
In most patients, an FEV1% less

than 70% indicates obstruction
SPIROMETRY
Any pulmonary function parameter

may be measured before and after
bronchodilator therapy
FEV1 and specific airway

conductance (SGaw) are usually
evaluated
SPIROMETRY
Lung volumes should be recorded

before bronchodilator
administration
Lung volumes and DLco may also

respond to bronchodilator therapy
SPIROMETRY
Routine bronchodilator therapy should be

withheld prior to spirometry
Ruppel 9th edition, pg. 66: Table 2-2

Short-acting -agonists
Short-acting anticholinergic
Long-acting -agonists
Long-acting anticholinergic
Methylxanthines (theophyllines)
Slow release methylxanthines
Cromolyn sodium
Leukotriene modifiers
Inhaled steroids
4 hours
4 hours
12 hours
24 hours
12 hours
24 hours
8-12 hours
24 hours
Maintain dosage
SPIROMETRY
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
Percentage of change is calculated
%Change = Postdrug Predrug X 100

Predrug
SPIROMETRY
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
Significance and Pathophysiology
Considered
significant if:
FEV1 or FVC increase 12% and 200 ml
SGaw increases 30% - 40%
SPIROMETRY
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
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
Maximal Inspiratory Pressure

(MIP)
The lowest pressure developed

during a forceful inspiration against
an occluded airway
Primarily measures inspiratory muscle

strength
SPIROMETRY
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
MIP
SPIROMETRY
MIP
Healthy adults > -60 cm H2O
Decreased in patients with:
Neuromuscular disease
Diseases involving the diaphragm,

intercostal, or accessory muscles
Hyperinflation (emphysema)
SPIROMETRY
MIP
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
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
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
MIP and MEP
SPIROMETRY
MEP
Healthy adults >80 to 100 cm H2O
Decreased in:
Neuromuscular disorders
High cervical spine fractures
Damage to nerves controlling

abdominal and accessory muscles of
inspiration
SPIROMETRY
MEP
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
Airway Resistance (Raw)
The drive pressure required to

create a flow of air through a
subjects 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
Raw
Measured in a
plethysmograph
as the patient
breathes
through a
pneumotachometer
SPIROMETRY
Raw
Criteria of Acceptability
Mean of three or more acceptable
efforts should be reported;
individual values should be within
10% of mean
SPIROMETRY

Normal Adult Values
Raw
0.6 2.4 cm H2O/L/sec
SRaw 0.190 0.667 cm H2O/L/sec/L
SPIROMETRY
May be increased in:
Bronchospasm
Inflammation
Mucus secretion
Airway collapse
Lesions obstructing the larger airways
Tumors, traumatic injuries, foreign bodies
SPIROMETRY
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
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
Gaw
Measured in a
plethysmograph
as the patient
breathes
through a
pneumotachometer
SPIROMETRY
Gaw
Criteria of Acceptability
Mean of three or more acceptable
efforts should be reported;
individual values should be within
10% of mean
SPIROMETRY

Normal Adult Values
Gaw
0.42 1.67 L/sec/cmH2O
SGaw 0.15 0.20 L/sec/cm H2O/L
SPIROMETRY

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.
b.
c.
d.
False
Only for those individuals with lung
disease
This applies only to cigarette smokers
True
Quiz Practice
Vital capacity is defined as which of
the following?
a.
b.
c.
d.
The volume of gas measured from a slow,

complete exhalation after a maximal
inspiration, without a forced effort
The volume of gas measured from a rapid,
complete exhalation after a rapid maximal
inspiration
The volume of gas measured after 3 seconds of
a slow, complete exhalation
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.
II.
III.
IV.
a.
b.
c.
d.
End-expiratory volume varies by less than 100

ml for three preceding breaths
Volume plateau observed at maximal inspiration
and expiration
Three acceptable vital capacity maneuvers
should be obtained; volume within 150 ml
Vital capacity should be within 150 ml of forced
vital capacity in healthy individuals
I, II, and IV
II, III, and IV
III and IV
I, II, III, IV
Quiz Practice
Which of the following best
describes the Forced Vital Capacity
(FVC) maneuver?
a.
b.
c.
d.

complete exhalation after a maximal
inspiration, without a forced effort
complete exhalation after a rapid maximal
inspiration
The volume of gas measured after 3 seconds
of a rapid, complete exhalation
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.
b.
c.
d.
Maximal effort, no cough or glottic

closure during the first second; no leaks
of obstruction of the mouthpiece
Good start of test; back extrapolated
volume less than 5% of the FVC or 150 ml
Tracing shows a minimum of 3 seconds of
exhalation
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.
b.
c.
d.
True
False
Only when done slowly
Only when divided by the FVC
Quiz Practice
Which of following statements is
true regarding FEV1?
a.
b.
c.
d.
FEV1 may be larger than the FVC

FEV1 is always 75% of FVC
May be reduced in obstructive and
restrictive lung disease
Is only reduced in restrictive disease
Quiz Practice
The FEV1% is useful in
distinguishing between obstructive
and restrictive causes of reduced
FEV1 values
a.
b.
c.
d.
True
False
Only helps to distinguish obstructive
lung disease
Only helps to distinguish restrictive
lung disease
Quiz Practice
Which statements are true
regarding the FEV 1%, also known
as the FEV1/FVC?
I.
II.
III.
IV.
a.
b.
c.
d.
A decreased FEV1/FVC is the hallmark of

obstructive disease
Patients with restrictive lung disease often
have normal or increased FEV1/FVC ratios
The presence of a restrictive disorder may
be suggested by a reduced FVC and a
normal or increased FEV1/FVC ratio
A normal FEV1/FVC ratio is between 75%
- 85%
I and II
I, II and III
II, III and IV
I, II, III and IV
Quiz Practice
What test is
represented by the
graph to the right?
a.
b.
c.
d.
Forced Vital Capacity

Flow-Volume Loop
Slow Vital Capacity
Total Lung Capacity
Maneuver
Quiz Practice
What type of pulmonary disorder is
represented by the graph below?
a.
b.
c.
d.
Obstructive lung disease

Restrictive lung disease
Upper airway obstruction
Normal lung function
(The dotted lines represent the predicted values)
Quiz Practice
Which is true regarding Peak
Expiratory Flow (PEF)?
I.
II.
III.
IV.
a.
b.
c.
d.
Primarily measures large airway function

Is a recognized means of monitoring
asthma
Serial measurements of PEF are used a
guide to treat asthma
When less than 50% of personal best, it is
an indication that immediate treatment is
required
I only
II and III
II, III, and IV
I, II, III, and IV
Quiz Practice
MVV is decreased in patients with
which of the following disorders?
I.
II.
III.
IV.
a.
b.
c.
d.
Moderate to severe obstructive lung

disease
Weak or with decrease endurance
Neurological defects
Paralysis or nerve damage
I and IV
II and III
III and IV
I, II, III, and IV
Quiz Practice
Spirometry before and after
bronchodilator therapy is used to
determine which of the following?
a.
b.
c.
d.
Reversibility of airway obstruction

The severity of restrictive disorders
The rate at which CO diffuses through the lung
into the blood
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.
b.
c.
d.
5 minutes
10 minutes
30 minutes
60 minute
Quiz Practice
Bronchodilation is considered
significant when which of the
following occurs?
a.
b.
c.
d.
FEV1/FVC increases by 12%

SGaw increases by 12%
FVC and/or FEV1 increases by 12% and 150 ml
DLco increases by 12%
Quiz Practice
Which of the following is true
regarding Maximal Inspiratory
Pressure (MIP)?
I.
II.
III.
IV.
a.
b.
c.
d.
Primarily measures inspiratory muscle

strength
Measures airway resistance during
inspiration
Is decreased in patients with neurological
disease
Often used in the assessment of
respiratory muscle function in patients
who need ventilatory support
I, II, and III

I, III, and IV
II and III
II, III, and IV
Quiz Practice
Airway resistance (Raw) is the
drive pressure required to create a
flow of air through a subjects
airway.
a.
b.
c.
d.
True
False
Only in patients with COPD
Only in patients with restrictive
disorders
Quiz Practice
Airway resistance may be increased
in which of the following patients?
I.
II.
III.
IV.
a.
b.
c.
d.
Purely restrictive lung disorders

Acute asthmatic episodes
Mucus secretion
Lung compliance changes
I only
I and IV
II and III
I, II, III, and IV
Quiz Practice
Airway Conductance (Gaw) is a
measure of flow that is generated
from the available drive pressure.
a.
b.
c.
d.
True
False
Only in patients with COPD
Only in patients with restrictive
disorders
Quiz Practice
A patients pulmonary function
tests reveal the following:
FVC
FEV1
Actual
4.01 L
2.58 L
FEV1% 51
Predicted
4.97 L
3.67 L
>75
Select the correct interpretation

a.
b.
c.
d.
Restrictive pattern
Obstructive pattern
Inconclusive
Normal
%Predicted
81
56
Quiz Practice
A patients pulmonary function tests reveal
the following:
FVC
FEV1
FEV1%
Actual
3.75 L
2.80 L
75
Predicted
4.97 L
3.67 L
>/=75
Select the correct interpretation

a.
Restrictive pattern
b.
Obstructive pattern
c.
Inconclusive
d.
Normal
%Predicted
75
76
_

Ho Hap Ky (Spirometry)

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H HP K

My o th tch theo thi gian:

My o lu lng theo th tch phi

MY HHK XCH TAY

Cc th tch v dung tch phi

Cc dung tch phi

Total Lung Capacity

Cc dung tch phi (tt)

Dung tch cn chc

FVC (Forced vital capacity):

FEV1 (Forced expiratory volume in one

T s FEV1/FVC (ch s Gaensler); FEV1/VC

FEF 25-75% (Forced Expiratory Flow

PEF ( Peak Expiratory Flow)(L/s):

PIF ( Peak Inspiratory Flow)(L/s):

MVV ( Maximal Volumtary Ventilation)

GIN TH TCH THEO THI GIAN

NG CONG LU LNG TH TCH

c da trn cc kho st trong dn s

Tiu chun cho mt h hp k bnh

ng cong lu lng - th tch

Tiu chun chn on hi chng tc

Tiu chun bnh phi hn ch

% d on > 80 hoc <

ng cong ch ri lon thng kh

Thi gian, giy

NG CONG LU LNG -TH

Cc dng ng cong lu lng th tch

nh gi cc triu chng, cc du hiu bnh

Tnh trng tim mch khng n nh

Phu thut mt, ngc, bng gn y

Trn kh mng phi

Cc tnh trng cp tnh nh chng mt,

Spirometry and Related Tests

SPIROMETRY AND RELATED TESTS

Determine whether spirometry is

Identify airway obstruction using forced

Differentiate between obstruction and

SPIROMETRY AND RELATED TESTS

Distinguish between large and small

Determine whether there is a significant

Select the appropriate FVC and FEV1 for

Laboratory Normal Ranges

tests performed on a large

Laboratory Normal Ranges

Laboratory Normal Ranges

clinical laboratories consider

When performing PFTs three values

Actual what the patient performed

Predicted what the patient should

% Predicted a comparison of the

VC: Criteria for Acceptability

End-expiratory volume varies by less than

Volume plateau observed at maximal

VC: Criteria for Acceptability

Three acceptable VC maneuvers should be

VC should be within 150 ml of FVC value

VC: Selection Criteria

Obstructive lung disease

Limitation of chest wall movement

If the VC is less than 80% of

If the VC is less than 80% of

Forced Vital Capacity (FVC)

FVC (should be within 150 ml of VC)