Measurements made

in pulmonary clinic
Ventilation
Distribution
Diffusion
 Ventilation deals with the measurement of the
body as an air pump, determining its ability to
move volumes of air and the speed with
which it moves the air
 Distribution measurements quantify degrees
of lung obstructions and also determine the
residual volume (amount of air that cannot be
removed)
 Diffusion measurements identify the rate at
which oxygen exchange takes place
Pulmonary function

 Evaluation of mechanical aspects of

pulmonary function, which affects the bulk
gas transport into and out of the lungs

 Evaluation of gas exchange or diffusion at

the alveoli
Respiratory volumes

 Tidal Volume: Volume of gas inspired or

expired during normal quiet breathing
 Minute volume: Volume of gas inspired or
expired per minute during quiet breathing
 Alveolar ventilation: Volume of fresh air
entering the alveoli with each breath
Respiratory volumes

Functional Residual Capacity: Volume of gas

Remaining in the lungs after normal expiration
Total Lung Capacity: Volume of gas in the
lungs at the point of maximal inspiration
Dead space: functional volume of the lung that
does not participate in gas exchange
Spirometry

 Used to measure lung capacity and volume

 Record obtained is spirogram

Volume Measuring
Spirometer
Flow Measuring Spirometer
Desktop Electronic
Spirometers
Small Hand-held Spirometers
Lung Volume Terminology

Inspiratory reserve Inspiratory

volume capacity

Total Tidal volume

lung
capacity
Expiratory reserve Vital
volume capacity

Residual volume
 Standard Spirometric Indicies
 FEV1 - Forced expiratory volume in one second:
The volume of air expired in the first second of the
blow
 FVC - Forced vital capacity:
The total volume of air that can be forcibly exhaled
in one breath
 FEV1/FVC ratio:
The fraction of air exhaled in the first second relative
to the total volume exhaled
Additional Spirometric Indicies
 VC - Vital capacity:
A volume of a full breath exhaled in the patient’s own
time and not forced. Often slightly greater than the
FVC, particularly in COPD

 FEV6 – Forced expired volume in six seconds:

Often approximates the FVC. Easier to perform in
older and COPD patients but role in COPD diagnosis
remains under investigation

 MEFR – Mid-expiratory flow rates:

Derived from the mid portion of the flow volume curve
but is not useful for COPD diagnosis
Predicted Normal Values

Affected by:
 Age
 Height
 Sex
 Ethnic Origin
Criteria for Normal
Post-bronchodilator Spirometry

 FEV1: % predicted > 80%

 FVC: % predicted > 80%

 FEV1/FVC: > 0.7

Normal Trace Showing FEV1 and
FVC

5 FVC
Volume, liters

4
FEV1 = 4L
3
FVC = 5L
2
FEV1/FVC = 0.8
1

1 2 3 4 5 6

Time, seconds
 Diseases Associated With
Airflow Obstruction

 Asthma
 Bronchiectasis
 Cystic Fibrosis
 Post-tuberculosis
 Lung cancer (greater risk in COPD)
 Obliterative Bronchiolitis
Unacceptable Trace – Stop
Early

Normal
Volume, liters

Time, seconds
Unacceptable Trace – Slow
Start

Normal
Volume, liters

Time, seconds
 Unacceptable Trace -
Coughing

Normal
Volume, liters

Time, seconds
Unacceptable Trace – Extra
Breath

Normal
Volume, liters

Time, seconds
Basic Spirometer

 Classic water sealed spirometer

 Consists of an upright, water filled cylinder
containing an inverted counter weighted bell
 Breathing into the bell changes the volume of
gases trapped inside and change in volume
is translated into vertical motion
 The spirometer is an mechanical integrator,
since the input is air flow and output is
volume displacement.
 An electrical signal proportional to volume
displacement can be obtained by using a
linear potentiometer connected to the pulley
portion of the spirometer.
 FEV1/FVC ratio
(Post bronchodilator)

Normal Normal

FEV1
Reduced (<70%)

Normal FEV1 reduced

Obstructive
defect
Look at FVC
Normal
spirometry

FVC reduced

Restrictive defect
Case 1
Case 2

a
A
A
A
A

Pulmonary Fibrosis (Asbestosis)

Body plethysmography

 The most accurate way

 The patient sits inside a fully enclosed rigid box and breath
through mouthpiece connected through a shutter to the
internal volume of the box
 The subject makes respiratory efforts against the closed
shutter (like panting), causing their chest volume to expand
and decompressing the air in their lungs.
 while breathing in and out again into a mouthpiece. The
volume of all gas within the thorax can be measured by
Changes in pressure inside the box and allow determination
of the lung volume.