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Spirometry and Related Tests. RET 2414 Pulmonary Function Testing. 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)

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spirometry and related tests

Spirometry and Related Tests

RET 2414

Pulmonary Function Testing

spirometry and related tests2
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 tests3
SPIROMETRY AND RELATED TESTS
  • Learning Objectives
    • Distinguish between large and small airway obstruction by evaluating flow-volume curves
    • Determine whether there is a significant response to bronchodilators
    • Select the appropriate FVC and FEV1 for reporting from series of spirometry maneuvers
spirometry airway function tests
Spirometry: Airway Function Tests

VC: Volume

The word spirometry means “the measuring of breath.” It is the most common of the Pulmonary Function Tests (PFTs).

It measures lung function, specifically the direct measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.

FVC: Volume & Flow

spirometry airway function tests5
Spirometry: Airway Function Tests
  • Vital Capacity (VC)
  • Forced Vital Capacity
  • Flow Volume Loop
    • Pre/Post Bronchodilator
    • Pre/Post Bronchochallenge
spirometry airway function tests6
Spirometry: Airway Function Tests
  • Maximum Voluntary Ventilation (MVV)
  • Maximal Inspiratory (MIP)
  • Expiratory Pressure (MEP)
  • Airway Resistance (Raw)
  • Compliance (CL)
indications for spirometry
Indications for Spirometry
  • Detect the presence of lung disease

Spirometry is recommended as the “Gold Standard” for diagnosis of obstructive lung disease by:

  • National Lung Health Education Program (NLHEP)
  • National Heart, Lung and Blood Institute (NHLBI)
  • World Health Organization (WHO)
indications for spirometry box 1 2
Indications for Spirometry BOX 1-2
  • Diagnose the presence or absence of lung disease
  • Quantify the extent of known disease on lung function
  • Measure the effects of occupational or environmental exposure
indications for spirometry box 1 29
Indications for Spirometry BOX 1-2
  • Determine beneficial or negative effects of therapy
  • Assess risk for surgical procedures
  • Evaluate disability or impairment
  • Epidemiologic or clinical research involving lung health or disease
spirometry
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.

spirometry11
SPIROMETRY
  • Vital Capacity
spirometry12
SPIROMETRY
  • Vital Capacity
    • Valid VC measurements important
      • IC and ERV used to calculate

RV and TLC

      • Example:
        • RV = FRC - ERV
        • TLC = IC + FRC
spirometry13
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

spirometry14
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

spirometry15
SPIROMETRY
  • VC: Selection Criteria

The largest single value from at least 3 acceptable maneuvers should be reported

spirometry16
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
spirometry17
SPIROMETRY
  • VC: Significance/Pathophysiology
    • Decreased VC
      • Obstructive lung disease
      • Respiratory depression or neuromuscular disease
      • Pleural effusion
      • Pneumothorax
      • Hiatal hernia
      • Enlarged heart
spirometry18
SPIROMETRY
  • VC: Significance/Pathophysiology
    • Decreased VC
      • Limited movement of diaphragm
        • Pregnancy
        • Abdominal fluids
        • Tumors
      • Limitation of chest wall movement
        • Scleraderma
        • Kyphoscoliosis
        • Pain
predicted values
Predicted Values
  • Laboratory Normal Ranges
    • Laboratory tests performed on a large number of normal population will show a range of results
predicted values20
Predicted Values
  • Laboratory Normal Ranges
predicted values21
Predicted Values
  • Laboratory Normal Ranges
    • Most clinical laboratories consider two standard deviations from the mean as the normal range since it includes 95% of the normal population.
pft reports
PFT Reports
  • When performing PFT’s three values are reported:
    • 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 reports23
PFT Reports
  • Example

ActualPredicted%Predicted

VC 4.0 5.0 80%

spirometry24
SPIROMETRY
  • VC: Significance/Pathophysiology
    • If the VC is less than 80% of predicted: FVC can reveal if caused by obstruction
spirometry25
SPIROMETRY
  • VC: Significance/Pathophysiology
    • If the VC is less than 80% of predicted: Lung volume testing can reveal if caused by restriction
spirometry26
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)

spirometry27
SPIROMETRY
  • FVC(should be within 150 ml of VC)
spirometry28
SPIROMETRY
  • FVC: Criteria for Acceptability
  • Maximal effort; no cough or glottic closure during the first second; no leaks or obstruction of the mouthpiece.
  • Good start-of-test; back extrapolated volume <5% of FVC or 150 ml, whichever is greater
spirometry29
SPIROMETRY
  • FVC: Criteria for Acceptability
  • 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
spirometry30
SPIROMETRY
  • FVC: Criteria for Acceptability
  • Three acceptable spirograms obtained; two largest FVC values within 150 ml; two largest FEV1 values within 150 ml
spirometry31
SPIROMETRY
  • FVC: Selection Criteria

The largest FVC and largest FEV1 (BTPS) should be reported, even if they do not come from the same curve

spirometry32
SPIROMETRY
  • FVC: When to call it quits !!!

If reproducible values cannot be obtained after eight attempts, testing may be discontinued

spirometry33
SPIROMETRY
  • FVC: Significance and Pathophysiology
    • FVC equals VC in healthy individuals
    • FVC is often lower in patients with obstructive disease
spirometry34
SPIROMETRY
  • FVC: Significance and Pathophysiology
    • FVC can be reduced by:
      • Mucus plugging
      • Bronchiolar narrowing
      • Chronic or acute asthma
      • Bronchiectasis
      • Cystic fibrosis
      • Trachea or mainstem bronchi obstruction
spirometry35
SPIROMETRY
  • FVC: Significance and Pathophysiology
    • 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
spirometry36
SPIROMETRY
  • FVC: Significance and Pathophysiology
    • FVC is also decreased in restrictive lung disease
      • Pulmonary fibrosis
        • dusts/toxins/drugs/radiation
      • Congestion of pulmonary blood flow
        • pneumonia/pulmonary hypertension/PE
      • Space occupying lesions
        • tumors/pleural effusion
spirometry37
SPIROMETRY
  • FVC: Significance and Pathophysiology
    • FVC is also decreased in restrictive lung disease
      • Neuromuscular disorders, e.g,
        • myasthenia gravis, Guillain-Barre
      • Chest deformities, e.g,
        • scoliosis/kyphoscoliosis
      • Obesity or pregnancy
spirometry38
SPIROMETRY
  • Forced Expiratory Volume (FEV1)

The volume expired over the first second of an FVC maneuver

spirometry39
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • FEV1 is the most widely used spirometric parameter, particularly for assessment of airway obstruction
spirometry40
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • FEV1 is used in conjunction with FVC for:
      • Simple screening
      • Response to bronchodilator therapy
      • Response to bronchoprovocation
      • Detection of exercise-induced bronchospasm
spirometry41
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • May be reduced in obstructive or restrictive patterns, or poor patient effort
spirometry42
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • 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
spirometry43
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • 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
spirometry44
SPIROMETRY
  • Forced Expiratory Volume (FEV1)
    • FEV1 may be reduced in restrictive lung processes
      • Fibrosis
      • Space-occupying lesions
      • Neuromuscular diseases
      • Obesity
      • Chest wall deformity
spirometry45
SPIROMETRY
  • Forced Expiratory Volume Ratio (FEVT%)
    • FEVT% = FEVT/FVC x 100
      • Useful in distinguishing between obstructive and restrictive causes of reduced FEV1 values
spirometry46
SPIROMETRY
  • Forced Expiratory Volume Ratio (FEVT%)
    • 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
spirometry47
SPIROMETRY
  • Forced Expiratory Volume Ratio (FEVT%)
    • A decrease FEV1/FVC ratio is the “hallmark” of obstructive disease
      • FEV1/FVC <75%
spirometry48
SPIROMETRY
  • Forced Expiratory Volume Ratio (FEVT%)
    • 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
spirometry49
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
spirometry50
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

spirometry51
SPIROMETRY
  • Flow – Volume Curve
    • AKA: Flow–Volume Loop (FVL)

The maximum expiratory flow-volume (MEFV) curve shows flow as the patient exhales from maximal inspiration (TLC) to maximal expiration (RV)

    • FVC followed by FIVC
spirometry52
SPIROMETRY
  • FVL
    • 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 25% or Vmax 75

FEF 75% or Vmax 25%

spirometry53
SPIROMETRY
  • FVL
    • FEVT and FEF% can be read from the timing marks (ticks) on the FVL
spirometry54
SPIROMETRY
  • FVL
    • Significant decreases in flow or volume are easily detected from a single graphic display
spirometry55
SPIROMETRY
  • FVL: Severe Obstruction
spirometry56
SPIROMETRY
  • FVL: Bronchodilation
spirometry57
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
spirometry58
SPIROMETRY
  • Peak Expiratory Flow (PEF)
    • 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
spirometry59
SPIROMETRY
  • Peak Expiratory Flow (PEF)
    • 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
spirometry60
SPIROMETRY
  • Peak Expiratory Flow (PEF)
    • 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)
spirometry61
SPIROMETRY
  • Maximum Voluntary Ventilation (MVV)

The volume of air exhaled in a specific interval during rapid, forced breathing

spirometry62
SPIROMETRY
  • MVV
    • Rapid, deep breathing
    • VT ~50% of VC
    • For 12-15 seconds
spirometry63
SPIROMETRY
  • MVV
    • Tests overall function of respiratory system
      • Airway resistance
      • Respiratory muscles
      • Compliance of lungs/chest wall
      • Ventilatory control mechanisms
spirometry64
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
spirometry65
SPIROMETRY
  • MVV
    • Selection Criteria
      • The highest MVV (L/min, BTPS) and MVV rate (breaths / min) should be reported
spirometry66
SPIROMETRY
  • MVV

Decreased in:

    • Patients with moderate to severe obstructive lung disease
    • Patients who are weak or have decreased endurance
    • Patients with neurological deficits
spirometry67
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
spirometry68
SPIROMETRY
  • Before/After Bronchodilator
    • Spirometry is performed before and after bronchodilator administration to determine the reversibility of airway obstruction
spirometry69
SPIROMETRY
  • Before/After Bronchodilator
    • An FEV1% less than predicted is a good indication for bronchodilator study
    • In most patients, an FEV1% less than 70% indicates obstruction
spirometry70
SPIROMETRY
  • Before/After Bronchodilator
    • Any pulmonary function parameter may be measured before and after bronchodilator therapy
    • FEV1 and specific airway conductance (SGaw) are usually evaluated
spirometry71
SPIROMETRY
  • Before/After Bronchodilator
    • Lung volumes should be recorded before bronchodilator administration
      • Lung volumes and DLco may also respond to bronchodilator therapy
spirometry72
SPIROMETRY
  • Before/After Bronchodilator
    • Routine bronchodilator therapy should be withheld prior to spirometry
      • Ruppel 9th edition, pg. 66: Table 2-2
      • Short-acting β-agonists 4 hours
      • Short-acting anticholinergic 4 hours
      • Long-acting β-agonists 12 hours
      • Long-acting anticholinergic 24 hours
      • Methylxanthines (theophyllines) 12 hours
      • Slow release methylxanthines 24 hours
      • Cromolyn sodium 8-12 hours
      • Leukotriene modifiers 24 hours
      • Inhaled steroids Maintain dosage
spirometry73
SPIROMETRY
  • Before/After Bronchodilator
    • 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
spirometry74
SPIROMETRY
  • Before/After Bronchodilator
    • Percentage of change is calculated

%Change = Postdrug – Predrug X 100

Predrug

spirometry75
SPIROMETRY
  • Before/After Bronchodilator
    • 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
spirometry76
SPIROMETRY
  • Before/After Bronchodilator

Significance and Pathophysiology

    • Considered significant if:
      • FEV1 or FVC increase ≥12% and ≥200 ml
      • SGaw increases 30% - 40%
spirometry77
SPIROMETRY
  • Before/After Bronchodilator

Significance and Pathophysiology

    • 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
spirometry78
SPIROMETRY
  • Before/After Bronchodilator

Significance and Pathophysiology

    • 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 related tests
SPIROMETRY & Related Tests
  • Maximal Inspiratory Pressure (MIP)
    • The lowest pressure developed during a forceful inspiration against an occluded airway
      • Primarily measures inspiratory muscle strength
spirometry related tests80
SPIROMETRY & Related Tests
  • 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 related tests82
SPIROMETRY & Related Tests
  • MIP

Significance and Pathophysiology

    • Healthy adults > -60 cm H2O
    • Decreased in patients with:
      • Neuromuscular disease
      • Diseases involving the diaphragm, intercostal, or accessory muscles
      • Hyperinflation (emphysema)
spirometry related tests83
SPIROMETRY & Related Tests
  • MIP

Significance and Pathophysiology

    • 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 related tests84
SPIROMETRY & Related Tests
  • 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 related tests85
SPIROMETRY & Related Tests
  • 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 related tests87
SPIROMETRY & Related Tests
  • MEP

Significance and Pathophysiology

    • Healthy adults >80 to 100 cm H2O
    • Decreased in:
      • Neuromuscular disorders
      • High cervical spine fractures
      • Damage to nerves controlling abdominal and accessory muscles of expiration
spirometry related tests88
SPIROMETRY & Related Tests
  • MEP

Significance and Pathophysiology

    • 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 related tests89
SPIROMETRY & Related Tests
  • Airway Resistance (Raw)
    • The drive pressure required to create a flow of air through a subject’s 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 related tests90
SPIROMETRY & Related Tests
  • Raw
    • Measured in a plethysmograph as the patient breathes through a pneumo-tachometer
spirometry related tests91
SPIROMETRY & Related Tests
  • Raw
    • Criteria of Acceptability
      • Mean of three or more acceptable efforts should be reported; individual values should be within 10% of mean
spirometry related tests92
SPIROMETRY & Related Tests
  • Airway Resistance (Raw)

Normal Adult Values

Raw 0.6 – 2.4 cm H2O/L/sec

SRaw 0.190 – 0.667 cm H2O/L/sec/L

spirometry related tests93
SPIROMETRY & Related Tests
  • Airway Resistance (Raw)
    • May be increased in:
      • Bronchospasm
      • Inflammation
      • Mucus secretion
      • Airway collapse
      • Lesions obstructing the larger airways
        • Tumors, traumatic injuries, foreign bodies
spirometry related tests94
SPIROMETRY & Related Tests
  • 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 related tests95
SPIROMETRY & Related Tests
  • 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 related tests96
SPIROMETRY & Related Tests
  • Gaw
    • Measured in a plethysmograph as the patient breathes through a pneumo-tachometer
spirometry related tests97
SPIROMETRY & Related Tests
  • Gaw
    • Criteria of Acceptability
      • Mean of three or more acceptable efforts should be reported; individual values should be within 10% of mean
spirometry related tests98
SPIROMETRY & Related Tests
  • Airway Conductance (Gaw)

Normal Adult Values

Gaw 0.42 – 1.67 L/sec/cmH2O

SGaw 0.15 – 0.20 L/sec/cm H2O/L

spirometry related tests99
SPIROMETRY & Related Tests
  • Airway Conductance (Gaw)

Significance and Pathology

      • SGaw Values <0.15 – 0.20 L/sec/cm H2O/L are consistent with airway obstruction
quiz practice
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.

  • False
  • Only for those individuals with lung disease
  • This applies only to cigarette smokers
  • True
quiz practice101
Quiz Practice

Vital capacity is defined as which of the following?

  • 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 practice102
Quiz Practice

Which of the following statements are true regarding the acceptability criteria for vital capacity measurement?

      • 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 practice103
Quiz Practice

Which of the following best describes the Forced Vital Capacity (FVC) maneuver?

  • 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 slow, 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 practice104
Quiz Practice

All of the following are true regarding the acceptability criteria of an FVC maneuver EXCEPT?

  • 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 practice105
Quiz Practice

The FEV1 is the expired volume of the first second of the FVC maneuver.

  • True
  • False
  • Only when done slowly
  • Only when divided by the FVC
quiz practice106
Quiz Practice

Which of following statements is true regarding FEV1?

  • 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 practice107
Quiz Practice

The FEV1% is useful in distinguishing between obstructive and restrictive causes of reduced FEV1 values

  • True
  • False
  • Only helps to distinguish obstructive lung disease
  • Only helps to distinguish restrictive lung disease
quiz practice108
Quiz Practice

Which statements are true regarding the FEV 1%, also known as the FEV1/FVC?

        • 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 practice109
Quiz Practice

What test is represented by the graph to the right?

  • Forced Vital Capacity
  • Flow-Volume Loop
  • Slow Vital Capacity
  • Total Lung Capacity Maneuver
quiz practice110
Quiz Practice

What type of pulmonary disorder is represented by the graph below?

  • Obstructive lung disease
  • Restrictive lung disease
  • Upper airway obstruction
  • Normal lung function

(The dotted lines represent the predicted values)

quiz practice111
Quiz Practice

Which is true regarding Peak Expiratory Flow (PEF)?

        • 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 practice112
Quiz Practice

MVV is decreased in patients with which of the following disorders?

        • 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 practice113
Quiz Practice

Spirometry before and after bronchodilator therapy is used to determine which of the following?

  • 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 practice114
Quiz Practice

What is the minimum amount of time between administration of bronchodilator therapy and repeat pulmonary function testing?

  • 5 minutes
  • 10 minutes
  • 30 minutes
  • 60 minute
quiz practice115
Quiz Practice

Bronchodilation is considered significant when which of the following occurs?

  • FEV1/FVC increases by 12%
  • SGaw increases by 12%
  • FVC and/or FEV1 increases by 12% and 200 ml
  • DLco increases by 12%
quiz practice116
Quiz Practice

Which of the following is true regarding Maximal Inspiratory Pressure (MIP)?

        • 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 practice117
Quiz Practice

Airway resistance (Raw) is the drive pressure required to create a flow of air through a subject’s airway.

  • True
  • False
  • Only in patients with COPD
  • Only in patients with restrictive disorders
quiz practice118
Quiz Practice

Airway resistance may be increased in which of the following patients?

        • 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 practice119
Quiz Practice

Airway Conductance (Gaw) is a measure of flow that is generated from the available drive pressure.

  • True
  • False
  • Only in patients with COPD
  • Only in patients with restrictive disorders
quiz practice120
Quiz Practice

A patient’s pulmonary function tests reveal the following:

Actual Predicted %Predicted

  • FVC 4.01 L 4.97 L 81
  • FEV1 2.58 L 3.67 L 56
  • FEV1% 51 >75 _

Select the correct interpretation

  • Restrictive pattern
  • Obstructive pattern
  • Inconclusive
  • Normal
quiz practice121
Quiz Practice

A patient’s pulmonary function tests reveal the following:

Actual Predicted %Predicted

FVC 3.75 L 4.97 L 75

FEV1 2.80 L 3.67 L 76

FEV1% 75 >/=75 _

Select the correct interpretation

  • Restrictive pattern
  • Obstructive pattern
  • Inconclusive
  • Normal