060531-肺功能检查-韩江娜

Lung Volumes
Indications
• Diagnose / assess restrictive lung disease • Assess hyperinflation in obstructive disease • Assess response to treatment
– Lung transplantation – Lung volume reduction – Radiation, chemotherapy
%Change 0 6% -66% 175%
Can you make a statement as to the patient’s underlying lung disease?
Case 5
PF 56 y/o female, 165 cm, 100 kg cough and dyspnea on exertion, exercise-induced bronchospasm suspected.
Interpretation of Spirometry
Look at Flow-Volume Loop
• • • • • Is it a good PFT’s? Is it normal? Characteristic pattern of obstruction? Pattern of restriction? Pattern of upper airway obstruction?
Spirometer：最古老的水鼓式
Volume displacement spirometer 滚筒式
Pneumotach 流速仪
Portable spirometer 便携式
Pocket sized spirometer
Body box 体描箱
Diffusion
What Information Does PFT Provide ?
Case 2
How to interpret the test?
Case 3.28 8.55 9 45 %Pred 40 28
Meas FVC FEV1 FEV1/FVC FEF25-75 PEF 1.85 0.92 50 0.28 3.82
Case 3
30 y/o male, 186 cm, 68 kg Severe interstitial fibrosis
How to interpret the spirometry?
Case 5
FVC FEV1 FEV1%
Spirometry Ref Meas 3.28 3.50 2.45 2.40 75 69
% 107 98
Case 5
What other tests do you order to answer the clinical question?
Data Quality in Spirometry
• Equipment standardization, calibration, and quality control • Test performance guidelines, criteria for acceptability of results • Technologist/technician training
• • • • The function of the airways The function of pulmonary parenchyma Pulmonary vasculature Respiratory muscle
Spirometry
Indications
• • • • • •
Detect lung disease (screening) Quantify extent of known disease Measure effect of environmental exposure Determine benefits/risks of therapy Assess surgical risk Evaluate disability or impairment
Case 6
SW 58 y/o female, 160 cm, 84 kg referred for dyspnea on exertion
1) Difficulty to perform spirometry 2) Audible stridor during expiration
Case 6
Normal Flow-Volume Loop
Cough
Variable Effort
Severe Obstruction
Restriction
Upper Airway Obstruction
Are the Data Consistent with Flow-Volume Curve?
Case 6
Case 6
Ref FVC FEV1 FEV1% TLC RV RV/TLC% DLCO Pre % Post % 79 23 %Change 0 -57 -57 3.00 2.39 80 2.38 2.22 1.18 53 0.51 74 49 21 4.73 4.03 85 1.72 1.64 95 37 41 Could not be performed
Summary
• Pulmonary function tests are valuable for the assessment of lung diseases. By ensuring proper calibration of equipment and performance of test maneuvers, one can differentiate among several different diseases.
Testing Guidelines
Spirometry
• Forceful expiration, no hesitation, at least 6 seconds • At least 3 acceptable maneuvers obtained • Two largest FVC and FEV1 values within 200 ml • Best test = largest FVC + FEV1
Criteria for Restriction
• Reduced TLC is a Golden standard • Reduced FVC with normal FEV1/FVC ratio is sensitive but lacks of specificity
Examine the response to bronchodilation
Case 1
How to interpret the test?
Case 1
Ref 3.41 2.53 74 2.77 6.10 15 65 %Pred 88 49
Meas FVC FEV1 FEV1/FVC FEF25-75 PEF 3.02 1.23 41 0.41 3.95
Case 2
A 55 year old male was evaluated preoperatively for cataract surgery.
Diffusion Capacity (DLCO)
Indications
• Follow progress of interstitial lung disease • Assess pulmonary involvement in systemic disease • Evaluate gas exchange in obstructive disease • Assess pulmonary vascular diseases • Quantify disability in interstitial lung disease
Case 4
How to interpret the test?
Case 4
Meas 6.79 4.29 63 9.04 1.92 4.03 0.055 % 116 95 114 92 406 24
FVC FEV1 FEV1% TLC RV Raw sGaw
Ref 5.84 4.53 77 7.92 2.08 0.99 0.23
Case 3
How to interpret the test?
Case 3
Meas 1.12 1.04 93 2.09 9 % 19 21 28 26
FVC FEV1 FEV1% TLC DLCO
Ref 6.01 4.89 81 7.45 35
Case 4
TD 29 y/o male, 185 cm, 80 kg, smoker, recurrent chest infections, having a morning cough, denied shortness of breath or wheezing.
• FEV1:
• 12% or more increase and 200ml increase
• sGaw*:
• 30-40% or more increase
* Chest 1992; 101:1572-1581
Case 1
A 60 year old female was evaluated for dyspnea on exertion .
Hyperventilation Challenge
Case 5
Hyperventilation Challenge
Case 5
What is the patient’s response to hyperventilation challenge?
Case 5
FVC FEV1 PEF