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Questions and Answers
Indications for spirometry include detecting the presence or absence of lung ______ suggested by history or physical signs and symptoms.
Indications for spirometry include detecting the presence or absence of lung ______ suggested by history or physical signs and symptoms.
dysfunction
A circumstance that could affect the reliability of spirometry measurements is ______ of unknown origin.
A circumstance that could affect the reliability of spirometry measurements is ______ of unknown origin.
hemoptysis
A potential hazard or complication of spirometry is ______ coughing.
A potential hazard or complication of spirometry is ______ coughing.
paroxysmal
Every day before testing, volume verification uses a calibrated known-volume ______ with a volume of at least 3 L to ascertain that the spirometer reads a known volume accurately.
Every day before testing, volume verification uses a calibrated known-volume ______ with a volume of at least 3 L to ascertain that the spirometer reads a known volume accurately.
If possible, computer software for measurement and computer calculations should be checked against ______ calculations.
If possible, computer software for measurement and computer calculations should be checked against ______ calculations.
Each laboratory or testing site should develop, establish, and implement quality ______ indicators for equipment calibration and maintenance and patient preparation.
Each laboratory or testing site should develop, establish, and implement quality ______ indicators for equipment calibration and maintenance and patient preparation.
The following should be evaluated during the performance of spirometric measurements to ascertain the validity of the results: Acceptability of maneuver and ______ of PVC and FEV₁.
The following should be evaluated during the performance of spirometric measurements to ascertain the validity of the results: Acceptability of maneuver and ______ of PVC and FEV₁.
Assess response to therapeutic interventions; transplantation, radiation, chemotherapy, ______.
Assess response to therapeutic interventions; transplantation, radiation, chemotherapy, ______.
With respect to whole-body plethysmography, factors such as ______, upper body paralysis, obtrusive body casts, or other conditions that immobilize or prevent the patient from fitting into or gaining access to the 'body box' are a concern.
With respect to whole-body plethysmography, factors such as ______, upper body paralysis, obtrusive body casts, or other conditions that immobilize or prevent the patient from fitting into or gaining access to the 'body box' are a concern.
One hazard and complication of measuring lung volumes is depressed ______ drive in susceptible subjects as a consequence of breathing 100% $O_2$ during the nitrogen washout.
One hazard and complication of measuring lung volumes is depressed ______ drive in susceptible subjects as a consequence of breathing 100% $O_2$ during the nitrogen washout.
Outcome and test quality are determined by ascertaining that the desired information has been generated for the specific indication and that ______ and reproducibility have been ensured.
Outcome and test quality are determined by ascertaining that the desired information has been generated for the specific indication and that ______ and reproducibility have been ensured.
Equipment calibration and quality control measures specific to measuring lung volumes should be applied and ______.
Equipment calibration and quality control measures specific to measuring lung volumes should be applied and ______.
[Blank] lung disease is a category of pulmonary disease.
[Blank] lung disease is a category of pulmonary disease.
Asthma is an example of an ______ lung disorder.
Asthma is an example of an ______ lung disorder.
[Blank] volume, inspiratory reserve volume, expiratory reserve volume, and residual volume are the four lung volumes.
[Blank] volume, inspiratory reserve volume, expiratory reserve volume, and residual volume are the four lung volumes.
Vital capacity, inspiratory capacity, functional residual capacity, and total lung ______ are the four lung capacities.
Vital capacity, inspiratory capacity, functional residual capacity, and total lung ______ are the four lung capacities.
Height, age, gender, and ______ are how we get the 'predicted' values.
Height, age, gender, and ______ are how we get the 'predicted' values.
The Ideal Body Weight for a male is: 106 + (6 x Ht Inches) / 2.2 = Ideal Body weight in ______.
The Ideal Body Weight for a male is: 106 + (6 x Ht Inches) / 2.2 = Ideal Body weight in ______.
[Blank] tests measure ability of lungs to move large volumes of air quickly through airways.
[Blank] tests measure ability of lungs to move large volumes of air quickly through airways.
main types of pulmonary function ______.
main types of pulmonary function ______.
[Blank] includes tests such as a 6 & 12 minute walk.
[Blank] includes tests such as a 6 & 12 minute walk.
FVC, SVC, MVV, RV/FRC, DLCO, and post FVC are all parts of a ______ PFT order.
FVC, SVC, MVV, RV/FRC, DLCO, and post FVC are all parts of a ______ PFT order.
[Blank] volume, inspiratory reserve volume, expiratory reserve volume, and residual volume are lung volumes.
[Blank] volume, inspiratory reserve volume, expiratory reserve volume, and residual volume are lung volumes.
Identify & quantify changes in pulmonary function due to ______ is one of the purposes of PFT.
Identify & quantify changes in pulmonary function due to ______ is one of the purposes of PFT.
[Blank] is an example of a contraindication to pulmonary function testing.
[Blank] is an example of a contraindication to pulmonary function testing.
Obstructive and ______ are the two main categories of pulmonary disease.
Obstructive and ______ are the two main categories of pulmonary disease.
Spirometers and pneumotachometers are examples of PFT ______.
Spirometers and pneumotachometers are examples of PFT ______.
Accuracy and precision are Elements of Quality ______.
Accuracy and precision are Elements of Quality ______.
Restrictive disease will not increase lung ______.
Restrictive disease will not increase lung ______.
[Blank] is used to measure airway mechanics.
[Blank] is used to measure airway mechanics.
The ______ vital capacity measures the most common test.
The ______ vital capacity measures the most common test.
[Blank] is the highest point on flow-volume graph.
[Blank] is the highest point on flow-volume graph.
It's important to know that the FEV1/______ should be at least 70%.
It's important to know that the FEV1/______ should be at least 70%.
Normal MVV for males is 160 to 180 L/min & slightly lower in ______.
Normal MVV for males is 160 to 180 L/min & slightly lower in ______.
Reversibility is defined as 12% & 200 ml from predose in FEV₁ &/or ______.
Reversibility is defined as 12% & 200 ml from predose in FEV₁ &/or ______.
Helium dilution is a technique used for measuring ______ volume.
Helium dilution is a technique used for measuring ______ volume.
Exercise is not a factor that can ______ the diffusing capacity of the lungs.
Exercise is not a factor that can ______ the diffusing capacity of the lungs.
Quality Assurance of Spirometry uses a 3.0 L syringe used for accuracy & precision of volume or ______.
Quality Assurance of Spirometry uses a 3.0 L syringe used for accuracy & precision of volume or ______.
One of three ways to perform measurements for residual volumes (RV) is ______.
One of three ways to perform measurements for residual volumes (RV) is ______.
FEV1/FVC is less than 70%, this would indicate; obstructive ______.
FEV1/FVC is less than 70%, this would indicate; obstructive ______.
The functional ______ capacity consists of expiratory reserve volume and residual volume.
The functional ______ capacity consists of expiratory reserve volume and residual volume.
The indications for spirometry include detecting the presence or absence of lung ______.
The indications for spirometry include detecting the presence or absence of lung ______.
A circumstance that could affect the reliability of spirometry is performing the procedure on someone with ______ of an unknown origin.
A circumstance that could affect the reliability of spirometry is performing the procedure on someone with ______ of an unknown origin.
Before each test, a calibrated known-volume ______ should be used to ascertain that the spirometer reads a known volume accurately.
Before each test, a calibrated known-volume ______ should be used to ascertain that the spirometer reads a known volume accurately.
A volume-displacement spirometer must be evaluated for ______ daily.
A volume-displacement spirometer must be evaluated for ______ daily.
Spirometry helps to differentiate between obstructive and ______ disease patterns.
Spirometry helps to differentiate between obstructive and ______ disease patterns.
Quantifying the amount of gas ______ is achieved by through comparing results of different lung function techniques.
Quantifying the amount of gas ______ is achieved by through comparing results of different lung function techniques.
The measurement and computer calculations of spirometry software should be regularly checked against ______ calculations for accuracy.
The measurement and computer calculations of spirometry software should be regularly checked against ______ calculations for accuracy.
The assessment of outcome and test quality is the outcome and test quality are determined by ascertaining that the desired information has been generated for the specific ______.
The assessment of outcome and test quality is the outcome and test quality are determined by ascertaining that the desired information has been generated for the specific ______.
The measurement of lung volumes require equipment calibration and ______ control measures specific.
The measurement of lung volumes require equipment calibration and ______ control measures specific.
A primary problem in ______ disease is a decrease in either lung compliance or lung volumes, or both.
A primary problem in ______ disease is a decrease in either lung compliance or lung volumes, or both.
Lung volumes and capacities are measured using volume measuring devices, also known as ______.
Lung volumes and capacities are measured using volume measuring devices, also known as ______.
Lung volumes and capacities can be measured using flow measuring devices also known as ______.
Lung volumes and capacities can be measured using flow measuring devices also known as ______.
Elements of quality assurance contains the ______ and precision of measuring instruments.
Elements of quality assurance contains the ______ and precision of measuring instruments.
During the maximal voluntary ventilation (MVV) test, the patient is asked to breathe deep and fast for ______ seconds.
During the maximal voluntary ventilation (MVV) test, the patient is asked to breathe deep and fast for ______ seconds.
A 3.0 L ______ is used for assurance of accuracy and precision of volume or flow.
A 3.0 L ______ is used for assurance of accuracy and precision of volume or flow.
Flashcards
Indications for Spirometry
Indications for Spirometry
Detect lung dysfunction, quantify severity, assess changes over time, evaluate exposure effects, and assess surgical risks.
Contraindications for Spirometry
Contraindications for Spirometry
Hemoptysis, pneumothorax, unstable cardiovascular status, aneurysms, recent eye surgery, or acute illness.
Hazards of Spirometry
Hazards of Spirometry
Pneumothorax, coughing, increased intracranial pressure, infection, syncope, desaturation, chest pain, and bronchospasm.
Volume Verification
Volume Verification
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Monitoring During Spirometry
Monitoring During Spirometry
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Indications for Lung Volume Determination
Indications for Lung Volume Determination
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Contraindications for Lung Volume Determination
Contraindications for Lung Volume Determination
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Hazards of Lung Volume Determination
Hazards of Lung Volume Determination
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Assessing Lung Volume Test Quality
Assessing Lung Volume Test Quality
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Four Lung Volumes
Four Lung Volumes
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Four Lung Capacities
Four Lung Capacities
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Factors for Predicted Values
Factors for Predicted Values
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Ideal Body Weight(Male)
Ideal Body Weight(Male)
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Ideal Body Weight(Female)
Ideal Body Weight(Female)
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Main Types of PFTs
Main Types of PFTs
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Other Types of PFTs
Other Types of PFTs
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Full PFT Includes
Full PFT Includes
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Tidal Volume (TV)
Tidal Volume (TV)
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Inspiratory Reserve Volume (IRV)
Inspiratory Reserve Volume (IRV)
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Expiratory Reserve Volume (ERV)
Expiratory Reserve Volume (ERV)
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Residual Volume (RV)
Residual Volume (RV)
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Purposes of PFTs
Purposes of PFTs
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Not Contraindication for PFT
Not Contraindication for PFT
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Categories of Pulmonary Disease
Categories of Pulmonary Disease
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Physiologic Patterns of Disease
Physiologic Patterns of Disease
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General Types of PFT Measuring Devices
General Types of PFT Measuring Devices
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Elements of Quality Assurance
Elements of Quality Assurance
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Not a Pathophysiologic Patterns of Pulmonary Disease
Not a Pathophysiologic Patterns of Pulmonary Disease
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Components of Measurement
Components of Measurement
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What Spirometry Tests?
What Spirometry Tests?
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Value of Spirometry Test
Value of Spirometry Test
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Forced Vital Capacity (FVC)
Forced Vital Capacity (FVC)
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What is FEV1?
What is FEV1?
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FEV1/FVC is calculated
FEV1/FVC is calculated
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Maximal Voluntary Ventilation (MVV)
Maximal Voluntary Ventilation (MVV)
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- 0 L Syringe
- 0 L Syringe
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What does FEV₁ indicate?
What does FEV₁ indicate?
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If Obstruction is Present
If Obstruction is Present
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FEV1/FVC < 70%
FEV1/FVC < 70%
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What Lung Capacities?
What Lung Capacities?
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Functional Residual Capacity Volume
Functional Residual Capacity Volume
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Techniques for Measuring Residual Volume (RV)
Techniques for Measuring Residual Volume (RV)
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Decreases Diffusing Capacity
Decreases Diffusing Capacity
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Study Notes
Introduction to PFTs
- Pulmonary Function Tests (PFTs) help assess lung function and diagnose respiratory conditions
Types of Pulmonary Function Tests
- Three main categories: Volume, Flow, Diffusion
- Other types are a 6 or 12 minute walk test, Peak Flow (PF), Maximum Inspiratory Pressure/Maximum Expiratory Pressure (MIP/MEP), and Arterial Blood Gas (ABG) analysis
Lung Volumes, Capacities, and Predicted Values
- Four primary lung volumes: Tidal Volume (VT), Inspiratory Reserve Volume (IRV), Expiratory Reserve Volume (ERV), Residual Volume (RV)
- Four lung capacities: Vital Capacity (VC), Inspiratory Capacity (IC), Functional Residual Capacity (FRC), Total Lung Capacity (TLC)
- Predicted values determined by Height, Age, Gender, and Race (HAGR)
Ideal Body Weight Calculation
- For males: Ideal Body Weight (IBW) = 106 + (6 x Height in inches) / 2.2 = IBW in kg
- For females: IBW = 105 + (5 x Height in inches) / 2.2 = IBW in kg
Full Pulmonary Function Test components
- Includes Forced Vital Capacity (FVC), Slow Vital Capacity (SVC), Maximum Voluntary Ventilation (MVV), Residual Volume/Functional Residual Capacity (RV/FRC), Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) and Post FVC
Lung Volumes and Capacities Explained
- Tidal Volume (TV): Volume of air entering or leaving lungs during a single breath
- Inspiratory Reserve Volume (IRV): Extra volume of air that can be maximally inspired over and above the typical resting tidal volume
- Inspiratory Capacity (IC): Maximum volume of air that can be inspired at the end of a normal quiet expiration, calculated as IC = IRV + TV
- Expiratory Reserve Volume (ERV): Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume
- Residual Volume (RV): Minimum volume of air remaining in the lungs even after a maximal expiration
Purposes of Pulmonary Function Testing (Indications)
- Identify and quantify changes in pulmonary function due to disease
- Evaluate the effectiveness of therapy
- Perform epidemiological surveillance for pulmonary disease
- Assess patients for the risk of postoperative complications
- Determine pulmonary disability
Pathophysiologic Patterns in Pulmonary Disease
- Two major categories of pulmonary disease: obstructive and restrictive
- Obstructive diseases primary abnormality is increased airways resistance
- Restrictive diseases primary problem is a decrease in either lung compliance or lung volumes or both
- Some pulmonary diseases can cause both obstructive and restrictive impairments
PFT Equipment Types
- Volume-measuring devices which are generically termed Spirometers
- Flow-measuring devices which are called Pneumotachometers
Quality Assurance Elements
- Accuracy and precision of measuring instruments
- Performance of Respiratory Therapist (RT)
- Test results when measuring against a known standard
Key Principles of Measurement
- Most pulmonary function laboratories have 3 key components
- Spirometry to measure airway mechanics
- Measurements of lung volumes and capacities
- Diffusion capacity measurements
- All 3 test components are required to identify the presence and degree of pulmonary impairment
Spirometry Tests
- Forced Vital Capacity (FVC)
- Forced Expiratory Volume in 1 second (FEV₁)
- Other forced expiratory flow measurements
- Maximum Voluntary Ventilation
Forced Vital Capacity (FVC)
- A common test that relies on patient effort and cooperation
- Requires careful patient instruction
- Requires at least 3 acceptable maneuvers to ensure validity
Important Spirometry Measures
- FEV1 represents the volume of gas exhaled in the first second of an FVC maneuver
- FEV1/FVC is calculated by dividing the largest FEV1 by the largest FVC
- FEF200-1200 is the average flow rate early in the FVC
- FEF25-75 is a measure of flow during the middle portion of the test
- PEFR (Peak Expiratory Flow Rate) represents the highest point on a flow-volume graph
Maximal Voluntary Ventilation (MVV)
- An effort-dependent test where the patient is asked to breathe deeply and quickly for 12 seconds
- Results reflect patient effort, function of respiratory muscles, chest wall ability to expand, and patency of airways
Quality Assurance of Spirometry
- A 3.0 L syringe is used for accuracy and precision of volume or flow measurements
- Multiple strokes at various injection speeds
- The average volume should be within +/- 3% standard
- 95% expected performance range should be determined
- Technologist performance should be observed and reviewed periodically
Significance of Spirometry Results
- Normal FEV₁ is 5.6 L for an average 20-year-old man
- FEV₁ is reduced with both obstructive and restrictive lung disease
- FEV1/FVC should normally be at least 70%
- Reduced with obstructive disease
- Normal with restrictive disease
- Other measures of expiratory flow are also reduced when obstructive disease is present
- Normal MVV for males is 160 to 180 L/min and slightly lower in females
- MVV is reduced in patients with moderate to severe obstructive lung disease
- MVV may be normal or slightly reduced in patients with restrictive disease
- Undernourished patients may have reduced MVV
Reversibility Testing
- If obstruction is present, reversibility must be evaluated with spirometry
- Spirometry is performed before and after therapy, with a bronchodilator administered typically via small-volume nebulizer or Metered Dose Inhaler (MDI)
- Criteria for reversibility include an increase of 12% and 200 ml from predose in FEV₁ and/or FVC
Techniques for Measuring Residual Volume (RV)
- Helium dilution is based on the fact that a known amount of helium will be diluted by the size of the patient's RV
- Nitrogen washout is based on the fact that 79% of RV is nitrogen, Volume of nitrogen exhaled ÷ 0.79 = RV
- Body box applies Boyle's law to measure RV
Key Interpretation Rule of Thumb
- An FEV1/FVC (FEV1%) < 70% always indicates an obstructive disorder.
- An FVC < 80% predicted in combination with a normal or high FEV1% defines a restrictive disorder.
Contraindications to Pulmonary Function Testing
- Hemoptysis of unknown origin
- Pneumothorax
- Unstable cardiovascular status
- Thoracic, abdominal, or cerebral aneurysms
- Recent eye surgery
- Acute disease processes
- Recent surgery of thorax or abdomen
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