Title: Pulmonary Function Test (Respiratory system)

Objectives:

1. To understand the spirometry technique.

2. To understand how the peak flow meter works.

3. To determine the composition of the total lung capacity

Introduction:

Spirometry is a standard test used by doctors to gauge the function of the lungs.

The test works by measuring the airflow into and out of your lungs. A medical device,

known as the spirometer is used to record the amount of air breathed in and out and the

speed of every breath. Spirometry tests are used to diagnose conditions such as

Chronic Obstructive Pulmonary Disease (COPD), asthma, restrictive lung disease and

other disorders affecting lung functions (Lung Function Tests. (n.d.)).

Principle:

The” Spiroanalyzer ST-75” is an electronic spirometer, that measures a patient’s

pulmonary function parameters through a well-ordered respiratory procedure. The

subject is required to inspire and expire ambient air in accordance with the prescribed

respiratory manoeuvre through a flow sensor that transforms the respiratory effort into

real-time differential pressure readings, then they are electronically submitted to a

processor for conditioning and processing and converted into a waveform or

computational data. The data is displayed on an LCD screen, printed on a hardcopy

printer, saved for archival purposes, or further presented as an input to other required
pulmonary function regimens. The instrument is capable of measuring a patient’s lung

functions and processing these data in a manner useful for clinical analysis.

Principle of operation:

Under room conditions, the patient is made to breathe air through the tubular portion of

the flow sensor following a prearranged breathing manoeuvre. Because the flow sensor

is a low-resistance free-flow tube, only differential pressure in the airflow path is used to

capture needed flow data.

The instrument has the following components:

1. Flow sensor / Transducer: the flow sensor uses a screen-type sensor that generates

the differential pressure signal. The signal is converted by a transducer into an

analogue electrical signal and sent over to the built-in Analogue-Digital-Converter (ADC)

of the system controller for processing.

2. System Controller is at the heart of the instrument. It provides central control over all

input/output components of the system. In addition, it has the ability to provide

processing functionality. It's (a) Keypad module is a 15-keypad instrument that serves

as the primary input device for the user to communicate interface with the application,

(b) LCD module provides visual display and feedback on the state of operation of the

system to the user, (c) Real-time clock provides the calendar and time information for

the system and (d) printer module provides the user with the hardcopy requirements of

the system.
The demographic data is entered into the main screen after creating a new ID.

Besides the main screen, the 3 other screens are

1. VC (Vital capacity)

2. FVC (Forced vital capacity)

3. MVV (Maximal ventilatory volume).

Apparatus:

Spirometer, peak flow meter

Method:

The power was turned on and was allowed to settle for 10 minutes. The information of

the subject was entered which included ID, temperature, age, height, weight, sex and

race. Upon a complete entry of the patient’s demographic data, [Fn] was pressed to

confirm the record’s registration. The machine computed these data to predict the

expected normal values for respiratory parameters and stored them. [Esc] was pressed

to return to the main screen. A disposable mouthpiece was attached to the flow sensor

through which the subject breathed. For each subject, a separate mouthpiece was to be

used. The nostrils were closed by a nose clip and breathed through the mouth into the

mouthpiece. Screen 1 (VC) was shifted. 6 (VC) was pressed, new screen appeared.

Enter was pressed, and the recording on the screen was started. The manoeuvres were

done as follows. In the mouthpieces, 2 normal quiet breaths were taken by the subject

and a deep inspiration was taken followed by a slow but deep expiration. A maximum
capacity was breathed by the subject for accurate results. Stop (Δ) was pressed, and

the data was displayed and stored. Screen 2 (FVC) was shifted. 7 (FVC) was pressed.

A new screen appeared. Enter was pressed. The screen moved. A maximum inspiration

was taken by the subject followed by a quick, maximal expiration. Screen 3 (MVV) was

shafted by pressing 8 (MVV). The subject was hyperventilated ( breathed as deep as

possible and as fast as possible) for 12 seconds. All the manoeuvres were repeated for

the same subject and the best values amongst the minimum 2 recordings were

selected. A hard copy of the computed data and curve was obtained by pressing the

print button.

Precautions:
1. Care should be taken not to blow out saliva.
2. Contact with saliva reduces the sensitivity of the transducer screen.

All data were computed by the instrument, where the values were graphically presented

and the following actual values were displayed: VC, FVC, FEV1, FEV1%, PEFR, MMEF

(Maximal mid-expiratory flow), MEF (Maximal expiratory flow) and MVV (Maximal

ventilator volume). The predicted values of the same parameters and the percentage of

the predicted values achieved were also displayed. The type of respiratory pathology

was analysed based on the comparison between the data of the subject and the

expected data to determine the function of the lungs.

Principle:

Test on airflow obstruction can also be assessed by a peak flow meter which is

considered a simple, portable and cheap piece of equipment.

Method:

The reading of the pinter was ensured to zero. The patient was required to stand or sit

in a comfortable, upright position. The peak flow meter level was held horizontally and

the fingers were kept away from the pointer. The nose was closed with a nose clip. A

deep breath was taken and lips were closed firmly around the mouthpiece. Air was

blown as hard as possible into the mouthpiece. The reading was checked by looking at

the position of the pointer. The reading of the pointer was set back to zero. The steps

were repeated three times and the highest reading was recorded.

This machine measured the maximal rate of flow which was achieved during forced

expiration. Healthy individuals will achieve values greater than 400 l /min. Patients with

fibrosis and restrictive changes may also record normal expiratory flow rates. Hence,

the meter was not suitable for the assessment of complicated pulmonary issues.

Patients with airflow obstruction would record reduced flow rates with values below 200

l /min being very significant and those below 100 l /min being severe.
Result:
Discussion:

The pulmonary function test can be carried out using a spirometer and a peak flow

meter to determine the composition of the vital capacity of a patient. Apart from that, the

maximal flow rate during forceful expiration by the subject can also be determined.

Pulmonary function tests are non-invasive tests that show how well the lungs are

functioning. The information obtained can help healthcare providers to diagnose and

decide on the treatment of certain lung disorders. The normal value of the FEV 1/FVC

ratio is 80% and the normal rate of peak expiratory flow rate is 500 – 600 L per min.

There are two types of airway problems which are obstructive and restrictive. If

FEV1/FVC ratio is less than 80%, it is classified as an obstructive disease. This disease

causes airway resistance to increase and more time is required to fill up or empty the

lungs. Examples are Chronic Obstructive Pulmonary Disease (COPD) and Bronchial

Asthma. On the other hand, if the value of the FEV 1/FVC ratio is equal to or more than

80%, it is a restrictive lung disease. Examples are fibrosis, scoliosis and weakness of

respiratory muscles.

Conclusion:

The spirometry technique used during pulmonary function tests is vital in determining

the patient’s health condition such as diagnosing breathing problems, asthma and

Chronic Obstructive Pulmonary Diseases (COPD).

1. Lung Function Tests. (n.d.). Retrieved from https://www.lung.org/lung-

health-and-diseases/lung-procedures-and-tests/lung-function-tests.html