PFTs ACOI Board Review 2018

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1 PFTs ACOI Board Review 2018 Thomas F. Morley, DO, MACOI, FCCP, FAASM Professor of Medicine Chairman Department of Internal Medicine Director of the Division of Pulmonary, Critical Care and Sleep Medicine NOW ROWAN SOM

2 In order to compute normal predicted values you need THREE things Age Gender Height Lungs get smaller with age Men have bigger lungs Tall people have bigger lungs Actually you need Air temp, Baro Pressure, and race too

3 Prediction Equations Hankinson JL et al. Am. J. Respir Crit. Care Med. Jan 1, 1999; 159(1):

4 Crapo RO, Morris AH, Clayton PD, and Nixon CR. Lung Volumes in Healthy Nonsmoking Adults. Bull. Europ. Physiopathol. Respir. 1982; 8: FVC = *Height(inches) *Age(years) [Men] FVC = *Height(inches) *Age(years) [Women] FEV1 = *Height(inches) *Age(years) [Men] FEV1 = *Height(inches) *Age(years) [Women] FEV1% = Predicted FEV1 / Predicted FVC RV = *Height(inches) *Age(years) [Men] RV = *Height(inches) *Age(years) [Women] TLC = *Height(inches) *Age(years) [Men] TLC = *Height(inches) [Women]

5 To read spirometry you only really need THREE numbers FVC 80% or > predicted FEV1 80% or > predicted FEV1/FVC ratio 75% or greater

6 Data for spirometry can be presented in THREE ways Volume time curve Flow-Volume loop Numerical data

7 Normal VTC and FVL

8 Obstructed VTC and FVL

9 Obstruction Airway Collapse

10 Restricted VTC and FVL

11 Normal Flow Volume Loop

12

13 Cases Normal Restricted Obstructed Combined

14 Patient 1

15 Patient 1

16 Patient 1 Normal VT curve Early plateau 98% of volume out by 3 seconds

17 Patient 1

18 Patient 1 Normal FVL Top (exp) looks like triangle Bottom (inspir) looks like semi-circle

19 Patient 1

20 Patient 1

21 Patient 1 Normal no obstructive or restrictive defect

22 Patient 2

23 Patient 2

24 Patient 2 Early plateau on VTC But at a lower than predicted Volume

25 Patient 2

26 Patient 2 The FVL look like a cone Instead of a right triangle

27 Patient 2

28 Patient 2

29 Patient 2 A restrictive defect is present No obstructive defect

30 Patient 3

31 Patient 3

32 Patient 3 Early plateau on VTC But at a lower than predicted Volume

33 Patient 3

34 Patient 3 The FVL look like a cone Instead of a right triangle

35 Patient 3

36 Patient 3

37 Patient 3 A restrictive defect is noted No obstruction is present

38 Patient 4

39 Patient 4

40 Patient 4 VTC does not plateau Long exhalation time

41 Patient 4

42 Patient 4 The line between PEF And RV becomes concave Instead of straight Indicates airflow obstruction

43 Patient 4

44 Patient 4

45 Patient 4 A mild obstructive defect is noted. No restriction is identified by TLC TLC is used rather than FVC to determine restriction

46 Patient 5

47 Patient 5 Lack of a plateau for both the pre And post-bronchodilator VTCs Indicates obstruction. Long exhalation times Improved post BD

48 Patient 5 The line between PEF And RV becomes concave Instead of straight Indicates airflow obstruction. Improved post BD

49 Patient 5

50 Patient 5

51 Patient 5

52 Patient 5 Severe obstructive defect with significant improvement after bronchodilator treatment Air trapping is present No restriction is noted

53 Patient 6

54 Patient 6 Lack of a plateau for both the pre And post-bronchodilator VTCs Indicates obstruction. Long exhalation times No improvement with BD

55 Patient 6 The line between PEF And RV becomes concave Instead of straight Indicates airflow obstruction. Not improved post BD

56 Patient 6

57 Patient 6

58 Patient 6 Combined obstructive and restrictive defect

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