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PULMONARY FUNCTION TESTING Pat Allan Pulmonary, CC, Sleep, NeuroCC, Int Pulmonary Medicine

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Spirometry Lung volumes (plethysmography) Diffusion capacity COPD Asthma Vocal cord dysfunction Fixed airway obsruction Tracheomalacia Interstitial Lung disease Neuromuscular disease PULMONARY FUNCTION TESTING Methacholine Oscillimetry Exhaled nitric oxide Thoracic ultrasound

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Requires a cooperative patient Meet American Thoracic Society standards Asthma COPD Vocal cord dysfunction SPIROMETRY

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FEV must improve by 12%

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Asthma and COPD What do they have in common? Airway obstruction Lowers FEV1 Leaves the total amount of air blown out unchanged (FVC) FEV/FVC ration falls to < 70% 12% improvement in FEV suggests asthma SPIROMETRY

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SPIROMETRY IN COPD

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SPIROMETRY Normal flow volume curve

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Obstruction on a flow volume curve SPIROMETRY

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Flow volume curve SPIROMETRY

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Flow volume curve SPIROMETRY

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Lung volumes (plethysmography) Diffusion capacity Interstitial Lung disease Neuromuscular disease Pulmonary hypertension LUNG VOLUMES & DIFFUSION CAPACITY

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V 1 =V box P box /P 1

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Low total lung volume lung volumes (restrictive lung disease) Interstitial lung disease Neuromuscular disease Obesity Residual volume ILD normal NM disease increased Obesity decreased Inspiratory capacity Low in neuromuscular disease LUNG VOLUMES

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Measures carbon monoxide diffusion Low Any pulmonary vascular disease pHTN, CHF, PE Any parenchyaml destructive disease (COPD or ILD) High Fresh hemoglobin in the alveoli DIFFUSION CAPACITY

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IMPULSE OSCILLOMETRY

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EXHALED NITRIC OXIDE

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THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETY (ATS) WAS APPROVED BY THE ATS BOARD OF DIRECTORS, MAY 2011

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DYSPNEA PFT/FVL/NO OSCILLOMETRY METHACHOLINE THORACIC US ECHO OR CT IMAGING