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