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pulmonary function testing

Diagnostic procedure(s) that provde objective, quantifiable measures of lung function

carbon monoxide diffusing capacity

Marker of gas diffusion across the alveolar-capillary membrane

DLCO

This test is reduced in situations where impairment of gas transfer exists (abbreviation)

arterial blood gas; carbon monoxide diffusion capacity; gas dilution; body plethysmography

Procedures for evaluation of pulmonary function: 1)_____ 2)_____ 3)_____ 4)_____

spirometry

Measurement of the movement of air into and out of the lungs during various breathing maneuvers

spirometric graph

Curve resulting from maximum inhalation and exhalation preceded by normal breathing

tidal volume (VT)

Volume of air inhaled or exhaled during normal breathing

inspiratory reserve volume (IRV)

Amount of air inhaled over and above normal tidal volume after a normal tidal inspiration

expiratory reserve volume (ERV)

Amount of air that can still be expired by forceful expiration after the end of a normal tidal expiration

vital capacity (VC)

Volume of air that can be exhaled after a maximal inhalation

inspiratory capacity (IC)

Sum of inspiratory reserve volume and tidal volume

residual volume (RV)

Volume of air remaining in the lungs at the end of maximal exhalation

functional residual capacity (FRC)

Amount of air contained in the lungs at the end of normal expiration

total lung capacity (TLC)

Total lung volume

forced vital capacity (FVC)

The vital capacity (VC) performed at maximal efforts

forced expiratory volume (FEV)

Measured after maximal inhalation then exhalation

forced expiratory volume in 1 second (FEV1)

Amount of air moved over 1 second

flow volume loop

Term used to describe the graph resulting from plotting the forced vital capacity (FVC) against the forced expiratory volume in 1 second (FEV1)

VC (vital capacity)

IRV + VT + ERV = ?

IC (inspiratory capacity)

IRV + VT = ?

TLC (total lung capacity)

VC + RV = ?

FEV1; pulmonary disease; response to bronchodilators

Most important PFT; used to diagnose _____ and to predict _____

75-80%

The FEV1 should be at least _____ of FVC in normal pulmonary function

diagnostic purposes; monitoring purposes

Primarily, PFT's are performed for two reasons: 1) _____ and 2) _____

inability of patient to cooperate; technical problems; misinterpretation of results

Three reasons for a poor PFT study

assess effectiveness of therapeutic intervention(s); monitoring of patient(s) with known lung disease; monitoring of patient(s) receiving drugs known to cause pulmonary toxicity

Three reasons to monitor using PFT studies

evaluation of (patient/person) for insurance disability; lawsuits; epidemiologic surveys

Other reasons for performing PFT studies

mental status changes; patient does not understand directions; poor effort; advanced disease

Four reasons a patient may be unable to cooperate during a PFT study

leakage around mouthpiece; equipment inaccuracies

Two reasons for having technical problems during a PFT study

reduction in TLC (total lung capacity)

Hallmark of a restrictive disease

decrease in lung volumes without reduction of airflow; VC

A restrictive defect is characterized by an overall ____; a decrease in _____ may also be seen

TLC ≤80% of predicted value

Mild restrictive disease

TLC ≤65% of predicted value

Moderate restrictive disease

TLC ≤50% of predicted value

Severe restrictive disease

interstitial lung disease(s); infiltrative lung disease(s); chest wall disease(s); pleural disease(s)

General diseases associated with restrictive defect (4 of them)

collagen vascular disease; interstitial pneumonitis; hypersensitivity pneumonitis; pulmonary fibrosis; pulmonary edema

Interstitial lung disease associated with restrictive defect

kyphoscoliosis; ankylosing spondylitis; neuromuscular disease(s)

Chest wall diseases associated with restrictive defect

granulomatosis; tumor

Infiltrative lung diseases associated with restrictive defect

fibrothorax; pleural effusion; pneumothorax

Pleural diseases associated with restrictive defect

obesity; paralyzed diaphragm; ascites; pregnancy; flail chest

Other conditions associated with restrictive defect

reduction of airflow; conducting airways; decrease in diameter; loss of integrity

Obstructive defect is characterized by a(n) _____ through the _____ due to a(n) _____ or _____

FEV1

The most useful PFT in diagnosing obstructive defects

FEV1 to <70% of predicted value

Mild obstructive defect classification

FEV1 to <60% of predicted value

Moderate obstructive defect classification

FEV1 to <40% of predicted value

Severe obstructive defect classification

asthma; emphysema; chronic bronchitis; granuloma; tumor; mechanical obstruction of bronchi

Diseases associated with obstructive defect

bronchial smooth muscle contraction

Asthma is due to _____

airway collapse from loss of radial traction

Emphysema is due to _____

anatomic thickening of the bronchial walls

Chronic bronchitis is due to _____

4-4-4-0-4

Asthma: ↓FEV1 = ? ↓FEV1/FVC = ? ↑airway resistance = ? ↓DLCO = ? Response to bronchodilators = ? (use scale of 0 to 4 for response)

4-4-4-0-1

Chronic bronchitis: ↓FEV1 = ? ↓FEV1/FVC = ? ↑airway resistance = ? ↓DLCO = ? Response to bronchodilators = ? (use scale of 0 to 4 for response)

4-4-1-4-0

Emphysema: ↓FEV1 = ? ↓FEV1/FVC = ? ↑airway resistance = ? ↓DLCO = ? Response to bronchodilators = ? (use scale of 0 to 4 for response)

↓DLCO = 2

Differing PFT (and numeric value) in chronic bronchitis patient who smokes

response to bronchodilator(s) = 3

Differing test (and numeric value) in 20% of emphysemic patients

↓;↓;↓;↓;≥75%

Restrictive defects: FVC = ? RV = ? TLC = ? FEV1 = ? FEV1/VC% = ?

normal/↑; ↑; normal/↑; ↓; <75%

Obstructive defects: FVC = ? RV = ? TLC = ? FEV1 = ? FEV1/VC% = ?

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