Pulmonary function

tests
Prof. Abderrahim NEMMAR
Dept. of Physiology
Faculty of Medicine & Health Sciences
United Arab Emirates University

Lecture 4
Volume and Pressure Changes during Breathing
In respiratory physiology and medicine:
• Volumes → liters or ml
• Pressures → relative to atmospheric pressure
 Atmospheric pressure is the pressure exerted by air (any
gas) surrounding the body.
 At sea level, it is equal to the pressure exerted by a
column of mercury 760 mmHg high.
 Pressures are expressed a mmHg (or cmH2O) above or
below atmospheric pressure.
— Examples:

— 0 = 760 mmHg
— +10 = 770 mmHg

— -20 = 740 mmHg

Lungs Volumes and Capacities
• The lung volume changes increasing with
inspiration and decreasing with expiration. 2L
Bottle
• Even when we try to remove all air from our
lungs → certain volume of air remains and
cannot be expelled.
• There is a limit to the volume to which we can
expand our lungs.
• Several different Lung volumes can be measured 1.5 L
of water
• Combinations (sums) of certain respiratory
volumes are called Lung capacities and can also
be measured
• Changes in these volumes and capacities occur • Volume of water = 1.5 L
in disease and have diagnostic importance. • Capacity of bottle = 2 L
 Lungs Volumes and Capacities: Spirometry
• Spirometry is a method of measuring lung volumes and capacities
Lungs Volumes and Capacities: Spirometers
Modern Spirometers
Principles the same – measure air flow
Spirometry Measurements: Lung Volumes
Tidal volume (VT): The volume of air
that moves into and out of the lung
during a single and unforced breath.

Inspiratory Reserve Volume (IRV): The

maximum volume of air that can
inspired from the end of a normal
inspiration
Expiratory Reserve Volume (ERV): The
maximum volume of air that can
expired from the end of a normal
expiration

Residual Volume (RV): The volume of

air remaining in the lungs after a
maximum expiration.
 Cannot be measured by spirometry
 Can be measured by Helium dilution technique
Spirometry Measurements: Lung Capacities
• Lungs capacities are sums of two or more
of the lung volumes
• Inspiratory capacity (IC):
 Maximum volume of air that can
be inspired at the end of resting
expiration
 IC = VT + IRV
 Approx. 3,500mL
• Vital Capacity (VC):
 Maximum volume of air that can
be expired following a maximum
inspiration
 VC = VT + IRV + ERV
 Approx. 4,500mL
• Functional Residual Capacity (FRC):
 Volume of air remaining in the
lungs at the end of tidal expiration
 FRC: ERV + RV
 Approx. 2,200mL
• Total Lung Capacity (TLC):
 Volume of air in the lungs at the
end of maximum inspiration
TLC: VT + IRV + ERV + RV
 Approx. 5,700 mL
Lung volumes and capacities: Forced Expiratory Volume
in one second (FEV1) & Forced Vital Capacity (FVC)
• FVC: maximum volume of air
exhaled after maximum
inspiration (subject exhale as
much and as fast as possible)
• Percentage of FVC that can
be exhaled within certain
FVC
time frame
• FEV1 = percent of FVC that
can be exhaled within 1
second
• Normal FEV1 /FVC = 80%
 If FVC = 4000 ml, one
should expire 3200
ml in 1 sec
• FEV1 < 80% → obstructive
pulmonary disease (asthma)
Obstructive Disease
• Difficult to get air out of the lungs
• Obstruct expiration

• Examples:
 Chronic Obstructive Pulmonary Disease
(COPD)
 Asthma
Restrictive Disease
• Difficult to get air into the lungs
• “Restrict” inspiration

• Examples:
 Intersitial fibrosis
 Muscular diseases
 Chest wall deformities.
Lung Capacity and Disease

TLC
125
TLC IRV
100 VC TV
% Normal TLC

IRV ERV
75 TLC
VC
TV
50 FRC VC IRV
ERV RV TV
25 FRC ERV
RV FRC RV
0
Normal Obstructive Restrictive
• Obstructive Pulmonary Diseases: • Restrictive Pulmonary Diseases
 Associated with increased airway  More difficult for lungs to expand
resistance Vital capacity decreases
 Total lung capacity decreases
Residual volume increases (harder to
expire)
 Functional residual capacity increases
 Total lung capacity increases
Minute Ventilation

Total volume of air entering and leaving

respiratory system each minute

• Minute ventilation = VT x RR
• Normal Respiration Rate (RR) = 12 breaths/min
• Normal VT = 500 mL
• Normal minute ventilation =
 500 mL x 12 breaths/min = 6000 mL/min
Anatomical Dead Space
• Air in conducting zone
does not participate
in gas exchange
• Thus, conducting zone
= anatomical dead
space
• Dead space
approximately 150 mL
Dead Space and Ventilation

After Inspiration, During Expiration

Before Expiration

Alveolar air (taking part in gas

exhange) used to measure
alveolar ventilation (VA)

Alveolar Ventilation (VA): Volume of air reaching the gas

exchange areas per minute
Alveolar Ventilation (V A or minute alveolar ventilation)

• Volume of air reaching the gas exchange

areas per minute
• Alveolar ventilation =
(VT x RR) – (DSV x RR)

• Normal = 4200 mL/min

(500 mL/br x 12 br/min) – (150 mL/br X 12
br/min)
DSV: Dead space volume
Effect of breathing rate and depth on Alveolar Ventilation
Dead Tidal Breathing Minute Alveolar % effective
Space Volume Rate Ventilation Ventilation Ventilation
Volume (TV) (MVR) (AVR) (AVR/MVR)
(DSV)

Normal 150 ml 500 ml 12/min 6,000 4,200 70%

Subject ml/min ml/min

Slow deep 150 ml 1,200 ml 5/min 6,000 5,250 87.5%

breathing ml/min ml/min

Rapid 150 ml 200 ml 30/min 6,000 1,500 25 %

shallow ml/min ml/min
breathing

It is more efficient to increase Alveolar Ventilation by ↑ TV than by ↑ respiratory rate