Respiratory function tests objectively measure lung function for various clinical purposes, including detecting and quantifying cardiopulmonary disease and monitoring treatment response. Tests are classified as evaluating respiratory mechanics, pulmonary gas exchange, or exercise capacity. Spirometry assesses airflow by measuring the volume of air inhaled and exhaled; lung volumes are determined using inert gas dilution or plethysmography. Diffusing capacity measures how well gases transfer from the lungs to blood and indicates emphysema if decreased. Exercise tests observe patients under symptomatic conditions and differentiate cardiovascular from pulmonary limitations.
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RFT (Respiratory Function Testing)
Respiratory function tests objectively measure lung function for various clinical purposes, including detecting and quantifying cardiopulmonary disease and monitoring treatment response. Tests are classified as evaluating respiratory mechanics, pulmonary gas exchange, or exercise capacity. Spirometry assesses airflow by measuring the volume of air inhaled and exhaled; lung volumes are determined using inert gas dilution or plethysmography. Diffusing capacity measures how well gases transfer from the lungs to blood and indicates emphysema if decreased. Exercise tests observe patients under symptomatic conditions and differentiate cardiovascular from pulmonary limitations.
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Respiratory Function Testing
Tests done to provide objective
measures of lung function Clinical roles: Detecting & quantifying pulmonary impairment in cardiopulmonary disease Following the evolution of disease and monitoring response to treatment Monitoring the effects of environmental, occupational and drug exposure associated with lung injury Assessing preoperative risk Assessing disability and impairment Classification of tests: Respiratory mechanics Pulmonary gas exchange Exercise The movement of air into and out of the lungs Spirometry The test is using Spirometer Gives the volume of air can be displaced by the lungs Doesnt give indication of the absolute volume
Respiratory mechanics Lung Volume Methods Inert gas solution Subject breaths from closed circuit a gas mixture containing an inert marker gas, usually helium The helium equilibrates gradually with the gas in the lungs, this occurs in 5 to 10 min normally FRC After disconnection from the rebreathing circuit the subject inspires fully IC IC + FRC = TLC Whole body plethysmography subject sits within a large air-tight chamber and makes gentle breathing efforts against a shutter, which closes the airway at the mouth
Since the pressure within the rigid plethysmograph changes as lung volume changes, this allows calculation of thoracic gas volume total lung capacity and residual volume are derived by full inspiration and expiration immediately on opening the shutter Interpretation: increase in TLC occurs in most patients with symptomatic diffuse airway obstruction and asthma large increase is characteristic of emphysema
Forced expiration simplicity of both the maneuver and equipment required relative independence of the measurements on the effort applied by the patient, provided that its done without excessive initial effort The most commonly used index of mechanical function of the lungs in hospital is the 1s forced expiratory volume (FEV1) Interpretation: FVC <VC (N: FVC=VC) Increase effort in airway obstruction patient (Decrease FEV1) Muscle function perform forcible static inspiratory and expiratory efforts against a closed airway Indicated for patient with neuromuscular problem Result may be confusing with COPD
Pulmonary Gas Exchange CO uptake Used widely as a simple test of the integrity of the alveolar capillary membrane and of the overall gas exchanging function of the lungs Good sensitivity but poor specificity Measure the effective surface area of alveoli Sequence: Subject takes a full inspiration of a gas mixture containing a very low concentration of CO Rate of uptake of gas is measured during breath holding for 10s Interpretation: Decrease diffusing capacity of CO emphysema
Exercise Test Allow observation of patients and their performance at a time when symptoms are present Assessing breathlessness Differentiate cardio and ventilation disease Types of tests: Simple self-paced tests of walking distance, most commonly in 6 min, aim to mimic the real life situation and are widely used for global assessment of disability Shuttle walk test. The subject increases his walking speed each minute, giving results which are more reproducible and closer to laboratory-based tests of maximum performance Bicycle ergometer or Treadmill Workload is increased by a constant amount, with periods of 1 to 3 min at each level Measurements include heart rate, ventilation, and gas exchange (O2 and CO2) and oxygen saturation by pulse oximetry Subject exercises at increasing loads until no longer able to continue because of discomfort, or until stopped by the investigator Interpretation: Cardiovascular problem limit exercise by max. HR Pulmonary problem limit exercise by max. ventilation achievable Asthma patient - bronchodilation Exercise induced bronchoconstriction