1 Usage of Pulmonary Usage of Pulmonary Function Tests in Function Tests in Clinic Except Clinic Except Spirometry Diffusion Spirometry Diffusion Capacity Capacity Prof.Dr.Birsen MUTLU Prof.Dr.Birsen MUTLU I.U.Cerrahpasa Medical Faculty I.U.Cerrahpasa Medical Faculty Department of Pulmonary Diseases Department of Pulmonary Diseases
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Usage of Pulmonary Function Tests in Clinic Except Spirometry Diffusion Capacity
Usage of Pulmonary Function Tests in Clinic Except Spirometry Diffusion Capacity. Prof.Dr.Birsen MUTLU I.U.Cerrahpasa Medical Faculty Department of Pulmonary Diseases. Pulmonary Function Tests Application Field. 1-Diagnosis and treatment of Lung and Heart diseases - PowerPoint PPT Presentation
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Usage of Pulmonary Function Usage of Pulmonary Function Tests in Clinic Except Tests in Clinic Except
I.U.Cerrahpasa Medical FacultyI.U.Cerrahpasa Medical Faculty Department of Pulmonary DiseasesDepartment of Pulmonary Diseases
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Pulmonary Function Tests Application FieldPulmonary Function Tests Application Field
1-Diagnosis and treatment of Lung and 1-Diagnosis and treatment of Lung and Heart diseases Heart diseases
2-Preoperative evaluation2-Preoperative evaluation3-Evaluation of disability3-Evaluation of disability4-Epidemiologic studies for the 4-Epidemiologic studies for the
evaluation of industrial diseasesevaluation of industrial diseases5-Simple determination of disease 5-Simple determination of disease
incidence in a given population incidence in a given population
2.Forced vital capacity maneuver2.Forced vital capacity maneuver a-FVC,FEV1,FEF,PEFa-FVC,FEV1,FEF,PEF (1)Prebronchodilator and postbronchodilator(1)Prebronchodilator and postbronchodilator (2)Prebronchochallenge and (2)Prebronchochallenge and
postbronchochallengepostbronchochallenge
b-MEFV curves,Vmaxb-MEFV curves,Vmaxxx
(1)Prebronchodilator and Postbronchodilator(1)Prebronchodilator and Postbronchodilator (2)Prebronchochallenge and (2)Prebronchochallenge and
5.Airway resistance (Raw) and 5.Airway resistance (Raw) and Compliance (C)Compliance (C)
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B-Lung volumes and ventilationB-Lung volumes and ventilation 1.Functional residual capacity (FRC)1.Functional residual capacity (FRC) a.Open-circuit (N2 washout)a.Open-circuit (N2 washout) b.Closed-circuit/rebreathing ([He dilution)b.Closed-circuit/rebreathing ([He dilution) c.Thoracic gas volume (Vc.Thoracic gas volume (VTGTG)) 2.Total lung capacity (TLC),residual 2.Total lung capacity (TLC),residual
volume (RV),RV/TLC ratiovolume (RV),RV/TLC ratio 3.Minute ventilation,alveolar ventilation and 3.Minute ventilation,alveolar ventilation and
dead space dead space 4.Distribution of ventilation4.Distribution of ventilation a.Multiple-breath N2a.Multiple-breath N2 b.He equilibrationb.He equilibration c.Single-breath techniquesc.Single-breath techniques
2. Tests with exhaled gas analysis2. Tests with exhaled gas analysis
3. Tests with blood gas analysis3. Tests with blood gas analysis F- F- Metabolic measurementsMetabolic measurements
Pulmonary Function TestsPulmonary Function Tests
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DIFFUSIONDIFFUSION
This is an electrochemical event This is an electrochemical event between gas and liquid. Occurs due between gas and liquid. Occurs due to the partial pressure difference of to the partial pressure difference of the gases.the gases.
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DIFFUSION CAPACITYDIFFUSION CAPACITY
Amount of gas (mL) passed through Amount of gas (mL) passed through the capillary membrane in a given the capillary membrane in a given time(1min) and in a given pressure time(1min) and in a given pressure difference (1mmHg) difference (1mmHg) (mL/min/mmHg)(mL/min/mmHg)
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DIFFUSION VELOCITYDIFFUSION VELOCITY
V=A.k.α.(PV=A.k.α.(P11--PP22))
hhV=Diffusion velocity within a given timeV=Diffusion velocity within a given timeA=Diffusion surface areaA=Diffusion surface areak=diffusion constantk=diffusion constantα=gas solubilityα=gas solubilityPP1-1-PP22= Partial pressure difference of two = Partial pressure difference of two
environment that the diffusion takes environment that the diffusion takes place in.place in.
h=membrane thicknessh=membrane thickness
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Factors that effect diffusion velocityFactors that effect diffusion velocity
-k (diffusion constant)-k (diffusion constant)-Α (solubility)-Α (solubility)-Viscosity of diffusion milieu-Viscosity of diffusion milieu
Air diffusion velocity>water diffusionAir diffusion velocity>water diffusion velocityvelocity
Factors that effect DFactors that effect DLLCO CO measurementmeasurement
1-Age,height,body surface area1-Age,height,body surface area
2-Cigarette smoking2-Cigarette smoking
3-Hemoglobin level3-Hemoglobin level
4-Body position and exercise4-Body position and exercise
5-Lung volumes5-Lung volumes
6-Inspiration and expiration maneuver6-Inspiration and expiration maneuver
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Factors that effect DFactors that effect DLLCO CO measurementmeasurement
7-Altitude7-Altitude
8-Oxygen concentration8-Oxygen concentration
9-Diurnal distribution9-Diurnal distribution
10-Menstrual cycle10-Menstrual cycle
11-Drinking alcohol11-Drinking alcohol
12-Sex and marital status12-Sex and marital status
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Age, height, body surface areaAge, height, body surface area
in children Din children DLLCOCO**AgeAge in elderly Din elderly DLLCOCO
** Body surface area, Body surface area, height, height, DLCO DLCOmuscle structuremuscle structure
**Weight has no effectWeight has no effect
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Cigarette smokingCigarette smoking
Chronic cigarette smoking DChronic cigarette smoking DLLCO and KCOCO and KCO
Acute smoking,Acute smoking,Occupational CO exposure alveolar CO pressureOccupational CO exposure alveolar CO pressureFrequently repeated testFrequently repeated test
**Decreased measurement due to smoking is Decreased measurement due to smoking is maksimum 10%.maksimum 10%.
**Must stop smoking at least 24 hours earlierMust stop smoking at least 24 hours earlier**Modification must be done in frequent smokersModification must be done in frequent smokers
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Hemoglobin levelHemoglobin level
Hb DHb DLLCO CO
Hb DHb DLLCOCO
-1 gram change in Hgb will change D-1 gram change in Hgb will change DLLCO 7%CO 7%
-Measured D-Measured DLLCO value: Standardized due to CO value: Standardized due to Hgb:14.6g/dLHgb:14.6g/dL
-D-DLLCO must be corrected due to changes in CO must be corrected due to changes in Hgb Hgb
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Body position and exerciseBody position and exercise
**In active persons DIn active persons DLLCO and DCO and DLLCO/VCO/VAA
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Lung VolumesLung Volumes
Volumes DVolumes DLLCO CO
To detect actual diffusion loss ;To detect actual diffusion loss ;
DDLLCO/VCO/VAA (KCO) must be (KCO) must be usedused
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Inspiration and Expiration Inspiration and Expiration ManeuversManeuvers
ValsalvaValsalva
maneuversmaneuvers
MullerMuller
effect effect
intrathoracicintrathoracic
pressurepressure
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AltitudeAltitude
Altitude Altitude FFIOIO22 D DLLCOCO **Correction may be necessaryCorrection may be necessary
Oxygen concentrationOxygen concentration
There is negative correlation between PThere is negative correlation between PAAOO2 2
and Dand DLLCOCO * * No ONo O2 2 supplemantationsupplemantation during testduring test
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Diurnal alterationDiurnal alteration
DDLLCO reaches Peak level in the morningCO reaches Peak level in the morning **During daytime During daytime progressively progressively 1-2%) per hour1-2%) per hour
Menstrual cycle and parityMenstrual cycle and parity
-~13% change during cycle -~13% change during cycle (Changes are due to Hgb effect)(Changes are due to Hgb effect)
-No significant change during parity-No significant change during parity
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Alcohol drinkingAlcohol drinking
15-30ml 95% alcohol will decrease 15-30ml 95% alcohol will decrease DDLLCO 15% after 90 minutesCO 15% after 90 minutes
Sex and ethnic conditionSex and ethnic condition
DDLLCO in men > womenCO in men > women DDLLCO whites > blacksCO whites > blacks
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CLINICAL USAGECLINICAL USAGEDecrease in DLCO ASSOCIATED WITH:Decrease in DLCO ASSOCIATED WITH:1-Obstructive lung diseases1-Obstructive lung diseases EmphysemaEmphysema Cystic fibrosisCystic fibrosis2-Parenchymal diseases2-Parenchymal diseases Interstitial pneumoniaInterstitial pneumonia Extrinsic allergic alveolitisExtrinsic allergic alveolitis Viral pneumoniaViral pneumonia Chronic interstitial fibrosis (silicos) Chronic interstitial fibrosis (silicos) Bronchioalveolar lung cancerBronchioalveolar lung cancer Drug reaction(bleomycin,nitrofurantoin)Drug reaction(bleomycin,nitrofurantoin) Alveolar proteinous and microlithyasisAlveolar proteinous and microlithyasis LymphangioleiomyomatosisLymphangioleiomyomatosis
FACTORS DECREASING DLCO WHICH ARE FACTORS DECREASING DLCO WHICH ARE INDEPENDENT FROM OTHER VENTILATORY INDEPENDENT FROM OTHER VENTILATORY PARAMETERSPARAMETERS
-Interstitial diseases that don’t effect -Interstitial diseases that don’t effect airflowairflow
5-Quantification of disability in interstitial 5-Quantification of disability in interstitial lung diseaseslung diseases
6-Detection of factors that increase D6-Detection of factors that increase DLLCOCO-polystemia-polystemia-pulmonary haemorrhage-pulmonary haemorrhage-left-right intracardiac shunt-left-right intracardiac shunt
7-Prediction of postoperative functional 7-Prediction of postoperative functional condition for preoperative evaluation condition for preoperative evaluation