PFT FOR ADULT

AND PEDIA

Overview
- Pulmonary Function Testing (PFT) is a
complete evaluation of the respiratory system
including patient history, physical
examinations, chest x-ray examinations,
arterial blood gas analysis, and test of
pulmonary function.
- The primary purpose of pulmonary function
testing is to identify the severity of pulmonary
impairment.
- Pulmonary function testing has diagnostic and
therapeutic roles and helps clinicians answer
some general questions about patients with
lung disease.

Purpose of PFT
To measure the different lung volumes and
capacities.
To distinguish the cause of abnormal gas
measurements.
To evaluate surgical risks.
To detect the early manifestation of
pulmonary disease.
To differentiate primary causative
abnormalities.
To evaluate disability for medical reasons.

Indications of PFT
Is indicated anytime than an assessment of
the respiratory system is required or
desired.
Specifically, PFT will evaluate the:
Presence of lung disease.
Extent of abnormal lung function.
Amount of disability due to the dysfunction.
Progression of the disease.
Response to therapy.

Lung Volumes
Tidal Volume (VT = 500ml) - The volume of
air routinely inhaled or exhaled during normal
respiration.
Inspiratory Reserve Volume (IRV =
3000ml) maximum volume of air inspired
from the end of the normal VT inspiration.
Expiratory Reserve Volume (ERV =
1000ml) maximum volume of air exhaled
from the resting expiratory level
Residual Volume (RV = 1500ml) air
remaining in the lungs after maximum
expiration.

LUNG CAPACITIES
Are combinations of two or more primary lung
subdivisions
Inspiratory Capacity (IC = 3500ml) = VT + IRV
Maximum volume of air that can be inhaled after a normal
exhalation.
Functional Residual Capacity (FRC = 2500ml) = ERV
+ RV Volume of air that remains in the lungs after a
normal exhalation.
Vital Capacity (VC = 4500ml) = VT + IRV + ERV
Maximum volume of air that can be exhaled after a
maximum inspiration
Total Lung Capacity (TLC = 6000ml) = VT + RV + IRV
+ ERV
Volume of air contained in the lungs at maximum inhalation

Lung Volume Compartments

and Subdivision

SPIROMETRY
Means the measuring of
breath
The most commonly
performed among the
Pulmonary Function Test
Measures lung function,
specifically the
measurement of the
amount (volume) and/ or
speed (flow) of air that
can be inhaled and
exhaled.
An important tool used
for assessing conditions
such as asthma, Cystic
Fibrosis and COPD

Spirometric Parameters
Forced Vital Capacity (FVC) The volume of
air that is forcefully exhaled after a
maximum inhalation is performed.
FEV 0.5 the volume of air exhaled during the
first one-half second of exhalation.
FEV1 the volume of air exhaled during the first
second of an FVC maneuver.
FEV3 the volume of air exhaled during an FVC
maneuver in three seconds
FEV1/FVC A parameter to use to distinguish
obstructive pulmonary disease from restrictive
pulmonary/normal conditions

FEF 25-75% - Forced Expiratory Flow Rate between 25 and

75%.
- average flow rate during the mid-portion of the FVC.
- decreased in the early stages of obstructive diseases.
- decreased values are associated with small airway
obstruction.
FEF 75-85% - Forced Expiratory Flow at 75-85%.
- the flow rate between 75-85% of the vital capacity.
FEF 200-1200 Force Expiratory Flow Rate between 200ml
and 1200ml.
- average flow during the first 1000 ml after 200ml expired.
- decreased values are associated with large airway
obstruction.
- typical value: 8 L/sec (480 L/min.)
Peak Expiratory Flow Rate (PEFR)
- effort dependent and may appear normal in abnormal patients.
- sometimes used to evaluate asthmatic patients, pre and post
bronchodilation.
- typical value: 10 L/sec. (600ml)

FLOW VOLUME LOOP

A graphical representation of flow plotted against
volume during FVC maneuver
Upper 25% of the curve flow reflects expiratory
muscle strength
Gradual decline in flow back to zero
Inspiratory loop deep curve plotted on the
negative portion of the flow axis

Normal Spirometry

Obstructive Pattern

Reduced FEV1 disproportionately more than FVC

Expiratory curve descends quicker, concave
shape
FEV1/FVC < 70%

Common Obstructive Diseases

Asthma
Asthmatic bronchitis
Chronic obstructive bronchitis
Chronic obstructive pulmonary
disease (COPD includes asthmatic
bronchitis, chronic bronchitis,
emphysema and the overlap between
them).
Cystic fibrosis
Emphysema

Restrictive
- Size of flow -volume loop is
relatively smaller
- FVC and TLC reduced

Common Restrictive Diseases

Idiopathic pulmonary fibrosis
Interstitial pneumonitis
Infectious inflammation (eg,
histoplasmosis, mycobacterium
infection)
Thoracic deformities
Congestive heart failure
Neuromuscular diseases

Performance of FVC maneuver

Check spirometer calibration.
Explain test.
Prepare patient.
Ask about smoking, recent
illness, medication use, etc.

Performance of FVC maneuver

(continued)
Give instructions and demonstrate:
Show nose clip and mouthpiece.
Demonstrate position of head with chin
slightly elevated and neck somewhat
extended.
Inhale as much as possible, put
mouthpiece in mouth (open circuit),
exhale as hard and fast as possible.
Give simple instructions.

Performance of FVC maneuver

(continued)
Patient performs the maneuver
Patient assumes the position
Puts nose clip on
Inhales maximally
Puts mouthpiece on mouth and closes lips around
mouthpiece (open circuit)
Exhales as hard and fast and long as possible
Repeat instructions if necessary be an effective
coach
Repeat minimum of three times (check for
reproducibility.)

Special Considerations in
Pediatric Patients
Ability to perform spirometry dependent
on developmental age of child,
personality, and interest of the child.
Patients need a calm, relaxed
environment and good coaching.
Patience is key.
Even with the best of environments and
coaching, a child may not be able to
perform spirometry. (And that is OK.)

Maximum Voluntary
Ventilation
Formerly called maximum breathing
capacity (MBC)
Effort dependent
Patient performs deep and fast breathing
for 12 seconds and the value of MVV is
extrapolated for the result
Evaluation of ventilatory reserves
NV: 150-200 L/min

Infant Pulmonary Function Test

Infant pulmonary function testing (iPFT) is a

way to measure the breathing of babies and
toddlers.
The test is done by having your child breathe
in a special machine to take measurements
of how much air is in his or her lungs.
The iPFT is done under sedation. That means
that your child will receive medication to
make him or her sleep through the test.

 Pulmonary function tests measure how well

your childs lungs are working.
They measure how fast air can flow
through the airways, how much air is in the
lungs and how stiff the lungs are.
This information is important in diagnosing
breathing problems and checking to see if
current treatments are working.
The results of these tests can show if your
childs lungs or airways are obstructed
(blocked) in any way because of asthma or
other conditions that affect breathing.

 In older children who are able to follow

instructions, lung function is checked
through a test called spirometry, which
measures breath capacity as a child
blows out into a tube.
When children are too youngor are
unableto follow instructions, lung
function is measured with infant
pulmonary function testing (iPFT).
iPFT uses special equipment to measure
lung function while the child is asleep.
iPFTs are very safe and can be
performed even on tiny babies.

Infant Pulmonary Function

Testing Procedure:
Your child will be given medication by mouth to
make him or her drowsy. This medication takes
effect in about 15 to
20 minutes. You may stay with your child as he or
she falls asleep and throughout the entire test.
After your child falls asleep, he or she will be
placed into a clear plastic device in which the lung
measurements will take place.
A thin strip of medical putty, will be rolled into a
cigar shape and pressed around the edge of a soft
plastic mask, which will be placed over your childs
mouth and nose. The putty will create an airtight
seal and give the mask a custom fit to your childs
face.

 The mask will be connected to a computer, which

will measure the airflow. As your child breathes into
the mask, the computer will measure how much air
is in your childs lungs.
A vest will be wrapped around your childs chest.
The vest will inflate very quickly to give your childs
chest a hug that will help your child blow all the
air out of the lungs. Before the hug, the doctor
may inflate the lungs with extra air through the
mask. The computer will measure how fast air can
flow into and out of your childs lungs.
Your child will be given a breathing treatment, such
as albuterol, through the mask to open your childs
lungs and breathing tubes. The tests will be
repeated to measure improvement.
The breathing tests will not hurt your child.

Example of Spirometers
Portable Spirometer
Spirometer

PC Based

COMPLETE PFT MACHINE

Nitrogen Wash-out, Open

Circuit Method
This method involves having the subject breathe 100%
O2, beginning at the resting expiratory level during normal
breathing.
At start, the FRC contained 80% nitrogen (N2).
The subject breathes 100% O2 until all N2 has been
washed out of the lung and replaced by O2.
When all N2 in the lungs has been replaced by O2, total
volume of gas is collected and measured (a) actual
amount of N2 is found (b) actual FRC can be calculated.
The RV is calculated by subtracting the spirometrydetermined ERV from the FRC: RV = FRC ERV
The TLC is calculated by adding the VC to the RV: TLC =
RV + VC

Helium Dilution Closed Circuit

Equilibration Method
Involves starting with a known amount of Helium
with the spirometer.
The subject breathes Helium until the lungs and
spirometer reach equilibrium.
The beginning Helium concentration in the lung is
zero.
With the known starting volume of gas and Helium
concentration in the spirometer and the new
Helium concentration after equilibrium, the
starting lung volume can be calculated.

Plethysmographic Method or
Body Box
Using Boyles Law to determine total thoracic gas volume at
FRC.
Measures gas trapped inside the lung and otherwise
excluded from the FRC with the other procedure (He dilution
and N2 washout).
Airway resistance (Raw) can be determined by measuring
the volume change per unit pressure change in liters/cmH20
or milliliters/cmH20 (Normal Compliance = 60-100
Ml/cmH20).
Advantage: it will more accurately measure FRC in patients
with obstructive lung disease.
Disadvantages: (a) patient may be unable to enter the box
due to physical limitations (b) claustrophobia prohibits
patient from entering box (c) patient may be unable to pant
acceptably.
Rapid, accurate, good for disease cases, but equipment is
expensive.