Spirometry

Mahler Beatrice, MD, PhD,

University Assistant, Physiopathology and
Immunology Chair I,
UMF “Carol Davila”,
 Pulmonary pysiology
There are three aspects of pulmonary function:
• Perfusion - relates to blood flow through pulmonary
vessels.

• Diffusion - refers to movements of oxigen and carbon

dioxide across capillary membranes

• Ventilation - relates to air excenge between alveolar

spaces and the atmosphere.
 Pulmonary pysiology
• In inspirations the alveolar pressure is lowered
below atmospheric pressure, and air flow into the
trachea, bronchi, bronchioles and alveoli.
• Expiration is a passive act, the lung –thorax sistems
recoil to their resting position and the alveolar
pressure increases above atmospheric pressure, then
the air flows out through the respiratory tract
 Spirometry
• The spirometry determines the effectiveness of the
various mechanical forces involved in lung and chest
wall movement.
• The value obtained provide quantitative information
about the degree of obstruction to airflow or the
degree of restriction of inspired air.
• The tests determine the presence, nature and
extent of pulmonary dysfunction caused by
obstruction, restriction or both.
 The ventilotory defect is:

• obstructive – increase air way resistence

• restrictive – limitation in chest wall excursion,
• mixed defect – the ventilation is altered by
both of mechanism.
 Restrictive ventilatory impairments
• chest wall disease – injuri, kyphoscoliosis,
spondylitis, muscular dystrophy,
• extratoracic conditions – obesity, peritonitis,
pregnancy,
• interstitial lung disease - fibrosis, sarcoidosis,
• pleural disease –fibrotorax, pleural effusions
• space-occuping lesions –tumor
 Obstructive ventilatory impairments
• periferal airway disease – COPD, bronchitis,
asthma
• pulmonary parenchimal disease –emphysema,
• upper airway disease – pharyngeal, tracheal
and laryngeal tumors, foreign bodies, stenosis
Mixed-defect ventilatory impairments
• pulmonary congestion
Major division of lung volumes
spirometry
 Procedure
• In the mornig of the investigation is contraindicaite to smoke, use
bronchodilatator.
• The pacient sit to the stool.
• Place nose clips on the nose, and instruct the patient to breathe
normally through a mounthpiece ( is a filter for bacterial or viral)
• Ask the pacient to take a maximal inspirations and then forcibly and
completely exhale into the spirometer
• have the pacient repeat this maneuver a minimum of three times.
• If the result is not normaly , you moust admistrate bronchodilators with
a handheld nebuliser and repeat spirometry is indicate.
 Atentions!

• Spirometry is a patient effort –dependent test

• The pain and altered mental status is a

contraindications for spirometry
Identifying errors in spirometry traces
Hesitation Premature finish

Cough

Poor effort Premature finish and restart

 Interpreting the results
Obstructive Restrictive Mixed

FEV1/FVC% Decreased increased Decreased

Or normal

FVC Decreased Decreased Decreased

Or normal

FEV1 Decreased Decreased Decreased

Or normal
the Normal flow volume curve
Severe Airflow Obstruction
Severe Restrictive Defect
subpleural bleb - emphysema
subpleural bleb - emphysema
 Bronchoprovocation

• Asymptomatic and normal PEF between attacks

• Symptoms < 1 time a week

• FEV1 –normal ( > 80 %)

• Metode – inhalator administration
– etacolina- for bronchobstructionM
– Ventolin - for bronhodilatation
 BODY PLETHYSMOGRAPHY
• pletysmograph
– It is a closed chamber with a fixed volume in
which the subject breathes the gas in the
plethysmograph.
– Measurement the TLC, RV, RAW( airway
resistence), TLco ( diffusion)
 Pulmonary diffusing capacity
• Requires the use of a gas that is more soluble
in blood than in lung tissue –carbon monoxide
• The diffusing capacity is measure for the
carbon monoxide and is converted to oxigen
by multiplying by 1.23.
• Is necessary to adjustment with hemoglobin
Lung Diffusing
 Lung Volume Terminology

Inspiratory reserve Inspiratory

volume capacity

Total Tidal volume

lung
capacity
Expiratory reserve Vital
volume capacity

Residual volume