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Updated: Dec 29 2021

Pulmonary Function Tests

  • Snapshot
    • A 23-year-old man presents to the emergency department with weakness. He states his legs were weak yesterday but now he is also having trouble breathing. He recently recovered from a diarrheal illness. The patient's forced vital capacity is significantly reduced and he is subsequently intubated (Guillain Barre syndrome).
  • Introduction
    • Clinical definition
      • spirometry
        • measures volume of expired air during forceful and complete exhalation
          • forced vital capacity (FVC)
            • total exhaled volume after a maximal inspiration
          • forced expiratory volume in 1 second (FEV1)
            • the volume exhaled in the first second of maximal expiration
          • FEV1:FVC ratio
            • low = obstructive disease
              • air can not get out quickly
              • concerning for obstructive disease (such as asthma)
            • normal/high = restrictive disease
              • no obstruction of airway
              • concerning for restrictive disease (such as pulmonary fibrosis)
        • flow-volume loops
          • plot out spirometry findings
            • normal
            • obstructive disease
            • restrictive disease
      • bronchoprovocation challenge
        • administration of bronchospastic agent (such as methacholine) followed by spirometry
          • can aid in diagnosis of asthma
  • Pulmonary Function Tests
    • MetricsDefinition
      • Ease of recoil after lungs have expanded
      • Ease of alveoli expansion
      Minute volume
      • Volume of air expired in 1 minute
      • =/↓
      Residual volume (RV)
      • Air left in lung after max expiration
      Total lung capacity (TLC)
      • All the air in the lung = vital capacity + residual volume
      Tidal volume
      • Volume of air breathed in and out for a normal breath
      Vital capacity
      • Total volume exhaled after full inspiration.
      Forced expiratory volume (FEV1) normal = 4L
      • Volume expelled in one second
      • =/↓
      Forced vital capacity (FVC)
      normal = 5L
      • Entire volume that can be expelled
      • =/↓

      normal = 80%

      • Considered best screen, values of less than 50% correlate with postoperative pulmonary complications.
      • =/↑
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