Pulmonary Function Testing (PFT)

Refers to a set of noninvasive tests that are used to examine

a patient’s respiratory system and identify the severity of
pulmonary impairment. The tests measure how well the
lungs are able to take in and release air, and how efficiently
they are able to exchange oxygen and carbon dioxide.
 Indications:
There are many different reasons to perform pulmonary function tests, including the
following:

• To assess changes in a patient’s pulmonary function

• To evaluate the effectiveness of treatment
• To diagnose pulmonary diseases
• To assess the progression of pulmonary diseases
• To differentiate between obstruction and restrictive diseases
• To differentiate types of obstructions
• To assess the risk for surgical procedures
• To assess postoperative complications
• To measure the effects of occupational exposure
• To evaluate level of fitness
• To evaluate impairment or disability

Keep in mind that each pulmonary function test has different indications. These are just a
few generals’ examples that can be applied to various types of tests.
Contraindications
PFTs are generally safe for most patients. However, they may be contraindicated in
certain situations, such as the following:

• Recent myocardial infarction

• Unstable angina
• Uncontrolled hypertension
• Hemoptysis
• Pneumothorax
• Acute pulmonary embolism
• Acute asthmatic attack
• Acute COPD exacerbation
• Recent cataract surgery

Again, each type of PFT may involve different risks and contraindications. These are just
a few general examples of when pulmonary function tests should not be performed.
Types of Pulmonary Function Tests
There are several different types of PFTs, each of which is used to assess a
specific aspect of lung function. Some examples include:

• Spirometry
• Lung volume measurements
• Forced vital capacity (FVC)
• Maximal voluntary ventilation (MVV)
• Maximal inspiratory/expiratory pressures (MIP/MEP)
• Body plethysmography
• Diffusing capacity
• Cardiopulmonary exercise tests
• Bronchoprovocation tests

Each test is performed using specialized equipment, and the results are
interpreted by doctors and respiratory therapists to gain insights about the health
of a patient’s lungs.
1. Spirometry
 is a pulmonary function test that measures a patient’s breathing patterns and lung
functionality. It uses a spirometer, which is a diagnostic device that measures the
volume and speed of airflow during a breathing cycle.

 Spirometry is used to diagnose lung conditions such as chronic obstructive pulmonary

disease (COPD), restrictive lung diseases, and other disorders that affect lung function.
In addition, this test is also used to assess how well a medication is working in patients
with asthma.

 Spirometry is a pulmonary function test that measures a patient’s breathing patterns

and lung functionality. It uses a spirometer, which is a diagnostic device that measures
the volume and speed of airflow during a breathing cycle.

 Spirometry is used to diagnose lung conditions such as chronic obstructive pulmonary

disease (COPD), restrictive lung diseases, and other disorders that affect lung function.
In addition, this test is also used to assess how well a medication is working in patients
with asthma.
2. Lung Volume Measurements
• Pulmonary function testing often involves the measurement of a
patient’s lung volumes. This includes:
• Tidal volume
• Inspiratory reserve volume
• Expiratory reserve volume
• Residual volume
• Various techniques can be used to measure lung volumes, including nitrogen
washout, helium dilution, and body plethysmography.
3. Forced vital capacity (FVC)
• is a common pulmonary function test that measures the total volume of air
that can be rapidly and forcefully exhaled after a maximum inspiration.
• It is helpful in determining if that patient has an obstructive or restrictive
lung condition. The maneuver is highly effort-dependent and requires
continuous coaching from the respiratory therapist in order to achieve
reliable results.
4. Body plethysmography
 is a pulmonary function test that measures the amount of
air that is inhaled and the amount of air that remains in the
lungs after exhalation.
 It is helpful in assessing how a disease is affecting a
patient’s lung function. It can also help confirm the
presence of a restrictive lung disease that may significantly
reduce the total lung volume.
 In addition, body plethysmography is one of the only tests
capable of measuring residual volume.
5. Maximal voluntary ventilation (MVV)
 is a pulmonary function test that measures the amount of air a person
can inhale and exhale in a short period of time. It requires the patient to
breathe as deep and fast as possible for 12 seconds.
 This test is used to assess the overall function of the respiratory system.
Decreased MVV results are an indication that an obstructive disease is
present.

6. Maximal Inspiratory/Expiratory Pressures

 measurements are obtained to assess a patient’s respiratory muscle
strength. They measure the force at which a patient can inhale and
exhale, respectively.
 MIP is the lowest pressure that can be generated during a maximal
inspiratory effort against an occluded airway.
 MEP is the highest pressure that can be generated during a maximal
expiratory effort against an occluded airway.
7. Diffusion Capacity
 The diffusing capacity for carbon monoxide (DLCO) is a pulmonary function test
that measures the amount of gas exchange taking place in the alveoli of the lungs.
 During the test, the patient inhales a low concentration of carbon monoxide (CO)
and a tracer gas and performs a breath-hold maneuver for 10 seconds. This allows
doctors and respiratory therapists to assess the patient’s diffusion capacity.
 The DLCO test is often indicated to monitor pneumoconiosis, evaluate obstructive
diseases, and monitor changes in lung function.

8. Cardiopulmonary exercise tests

 are often used to assess a patient’s oxygen uptake, carbon dioxide production, and
heart rate during physical activity. These measurements can be helpful in
determining the severity of a respiratory disease.
 An example is the 6-minute walk test (6MWT), which measures the total distance a
patient can walk in 6 minutes. The distance traveled has a correlation with the
clinical outcome of multiple pulmonary diseases.
 9. Bronchoprovocation test
 can be used to assess a patient’s airway
hyperresponsiveness, which is the narrowing of the airways
in response to certain triggers, such as allergens and irritants.
 One example is the methacholine challenge test in which a
patient inhales increasing concentrations of methacholine in
order to mimic the effects of asthma. If there are significant
changes in the patient’s FEV1, it helps with the diagnosis of
asthma.
CALCULATE THE PERCENTAGE CHANGE:
 Flow & Volume Measuring Devices:

VOLUME: FLOW:

Water-sealed spirometer  Differential-pressure pneumotachometer

Dry-sealed spirometer  Thermal anemometers
Bellows spirometer  Ultrasonic sensor spirometers
Rotor spirometer  Dedicated peak flow meters
 Types of Lung Diseases
There are two primary types of lung diseases:

1. Obstructive lung diseases

 include conditions that make it difficult to exhale air out of the lungs. They
cause the patient to experience shortness of breath due to narrowing of the
airways within the lungs, which results in decreased flow rates.
 A simple way to memorize the obstructive lung diseases is use the CBABE
mnemonic, which stands for cystic fibrosis, bronchiectasis, asthma,
bronchitis (chronic), and emphysema.

2. Restrictive lung diseases

 include conditions that make it difficult for patients to fully fill their lungs
with air on inhalation. Essentially, their lungs are restricted from fully
expanding, which results in decreased lung volumes.
 As a general rule of thumb, any pulmonary condition that isn’t classified as
one of the obstructive disease can be considered a restrictive lung disease.
Pulmonary Function Testing Normal Values:
A patient with normal, healthy lungs will achieve pulmonary function
test results with the following ranges:

• FEV1: > 80% of predicted

• FEV1/FVC%: ≥ 70%
• Forced Vital Capacity (FVC): > 80% of predicted
• Slow Vital Capacity (SVC): > 80% of predicted
• Airway Resistance (RAW): 0.6 – 2.4 cmH2O/L/sec
• Diffusing Capacity for Carbon Monoxide (DLCO): 20 – 25
mL/CO/min/mmHg
• Peak Expiratory Flow Rate (PEFR): 10 L/sec
• Exhaled Carbon Monoxide: < 7 for nonsmokers

If a patient’s PFT results are not within the normal value ranges, it helps
determine the type and severity of their respiratory condition.
Lung volume s:
• refers to the amount of air in the lungs at a
specific time during the breathing cycle. There
are four types of lung volumes, including:

1. Tidal Volume (VT)

2. Inspiratory Reserve Volume (IRV)
3. Expiratory Reserve Volume (ERV)
4. Residual Volume (RV)

• Tidal volume is the amount of air inhaled or

exhaled with each breath.
• Inspiratory reserve volume is the amount of
air that can be inhaled beyond a normal
inhalation.
• Expiratory reserve volume is the amount of air
that can be exhaled beyond a normal exhalation.
• Residual volume is the amount of air remaining
in the lungs after a maximal exhalation.
Lung capacities:
• is a combination of two or more lung
volumes. There are four types of lung
capacities, including:

1. Vital Capacity (VC)

2. Inspiratory Capacity (IC)
3. Functional Residual Capacity (FRC)
4. Total Lung Capacity (TLC)

• Vital capacity is the maximal amount of air

that can be exhaled after a maximal expiratory
effort.
• Inspiratory capacity is the maximal amount
of air that can be inhaled after a normal
exhalation.
• Functional residual capacity is the volume of
air remaining in the lungs after a normal
exhalation.
• Total lung capacity is the sum of all the lung
volumes.
 Gas distribution tests:
are used to measure a patient’s absolute lung volumes during a breathing cycle. The
Body plethysmography
three primary types include:Nitrogen washout Technique
• is a pulmonary function test
Helium Dilution Technique • is a pulmonary function test that measures the functional
• is a pulmonary function test that that is also used to measure a
residual capacity (FRC) and
measures a patient’s functional patient’s functional residual
residual capacity (FRC). capacity (FRC).
intrathoracic gas volumes.
• It involves the use of a spirometer • In general, atmospheric air • During the test, the patient
that is filled with a known volume contains approximately 79% enters a large box with a
of air. Then helium is introduced nitrogen. The test involves tight seal and rigid walls. It
into the lungs as the patient washing nitrogen out of the generates pressure, which
breathes through a valve connected lungs by having the patient causes the volume to shift
to a rebreathing system. breathe in 100% oxygen and while the expiratory flow
• The lungs act as a mixing chamber the total expired volume is rate is recorded.
where the helium mixes with the measured.
air that is already present. The • The changes in pressure and
• The FRC is calculated using airway resistance allow the
change in concentration of the
the initial nitrogen
helium is used to measure the FRC to be measured, which
FRC. Then you will be able to concentration, amount washed
is used to calculate the RV
calculate the residual volume and out, and the final
concentration. Then you can and TLC.
total lung capacity (TLC).
calculate the RV and TLC.
What is Airway Resistance?
• Airway resistance (Raw) is the measurement of the
opposition to airflow that occurs as air moves through the
airways of the lungs. It can be calculated with the
following formula:
• Raw = (PIP – Plateau pressure) / Flow
• Therefore, airway resistance is the difference between the
patient’s alveolar pressure and mouth pressure, divided
by the flow at the mouth.
GHHVK.
GHHVK.