肺功能檢查韓江娜

肺功能檢查韓江娜WhatPulmonaryFunctionTestsDoYouNeed?SpirometryLungVolumesBodyPlethysmographyDiffusingCapacity(DLCO)ArterialBloodGasAnalysisSpirometer：最古老的水鼓式Volumedisplacementspirometer

滾筒式Pneumotach

流速儀Portablespirometer

便攜式PocketsizedspirometerBodybox

體描箱DiffusionWhatInformationDoesPFTProvide?ThefunctionoftheairwaysThefunctionofpulmonaryparenchymaPulmonaryvasculatureRespiratorymuscleSpirometry

IndicationsDetectlungdisease(screening)QuantifyextentofknowndiseaseMeasureeffectofenvironmentalexposureDeterminebenefits/risksoftherapyAssesssurgicalriskEvaluatedisabilityorimpairmentLungVolumes

Indications

Diagnose/assessrestrictivelungdiseaseAssesshyperinflationinobstructivediseaseAssessresponsetotreatmentLungtransplantationLungvolumereductionRadiation,chemotherapyDiffusionCapacity(DLCO)

IndicationsFollowprogressofinterstitiallungdiseaseAssesspulmonaryinvolvementinsystemicdiseaseEvaluategasexchangeinobstructivediseaseAssesspulmonaryvasculardiseasesQuantifydisabilityininterstitiallungdiseaseDataQualityinSpirometryEquipmentstandardization,calibration,andqualitycontrolTestperformanceguidelines,criteriaforacceptabilityofresultsTechnologist/techniciantrainingTestingGuidelinesForcefulexpiration,nohesitation,atleast6secondsAtleast3acceptablemaneuversobtainedTwolargestFVCandFEV1valueswithin200mlBesttest=largestFVC+FEV1SpirometryInterpretationofSpirometry

LookatFlow-VolumeLoopIsitagoodPFT’s?Isitnormal?Characteristicpatternofobstruction?Patternofrestriction?Patternofupperairwayobstruction?NormalFlow-VolumeLoopCoughVariableEffort

SevereObstructionRestrictionUpperAirwayObstructionAretheDataConsistentwithFlow-VolumeCurve?FVC(VC):anexpressionoflungsizeFEV1:influencedbylungsizeandthedimensionsofairwayFEV1/FVC:ameasureofairwayobstruction(Tiffeneaucoefficient)ReducedFVConlysuggestsrestrictionCriteriaforRestrictionReducedTLCisaGoldenstandardReducedFVCwithnormalFEV1/FVCratioissensitivebutlacksofspecificityExaminetheresponsetobronchodilation

FEV1:12%ormoreincreaseand200mlincreasesGaw*:30-40%ormoreincrease*Chest1992;101:1572-1581Case1A60yearoldfemalewasevaluatedfordyspneaonexertion.

Case1Case1Howtointerpretthetest?Case2A55yearoldmalewasevaluatedpreoperativelyforcataractsurgery.

Case2Case2Howtointerpretthetest?Case3 30y/omale,186cm,68kg SevereinterstitialfibrosisCase3Case3

Ref Meas %FVC 6.01 1.12 19FEV1

4.89 1.04 21

FEV1% 81 93TLC 7.45 2.09 28DLCO 35 9 26Howtointerpretthetest?Case4TD29y/omale,185cm,80kg,smoker,recurrentchestinfections,havingamorningcough,deniedshortnessofbreathorwheezing.

Case4Case4

Ref Meas %FVC 5.84 6.79 116FEV1

4.53 4.29 95

FEV1% 77 63TLC 7.92 9.04 114RV

2.08 1.92 92Raw

0.99 4.03 406sGaw

0.23 0.055 24Howtointerpretthetest?Case4

Howtointerpretbronchodilatortest(spirometry,sGaw)?

BronchodilatorTest

Pre Post %ChangeFVC 6.79 6.81 0FEV1

4.29 4.56 6%

Raw 4.03 1.39 -66%sGaw 0.055 0.151 175%Canyoumakeastatementastothepatient’sunderlying

lungdisease?

Case5PF 56y/ofemale,165cm,100kgcoughanddyspneaonexertion,exercise-inducedbronchospasmsuspected.

Case5

Spirometry

Ref Meas %FVC 3.28 3.50 107FEV1

2.45 2.40 98

FEV1% 75 69Howtointerpretthespirometry?Whatothertestsdoyouordertoanswertheclinicalquestion?Case5Case5HyperventilationChallengeCase5HyperventilationChallengeCase5

Hyperventilation

Challenge

Pre Post %ChangeFVC 3.50 2.14 -39%FEV1

2.40 1.03 -57%

PEF 6.22 2.52 -59%Whatisthepatient’sresponsetohyperventilationchallenge?Case6SW 58y/ofemale,160cm,84kg referredfordyspneaonexertionCase61)Difficultytoperformspirometry2)AudiblestridorduringexpirationCase6Case6

Ref Pre % Post %%ChangeFVC 3.00 2.39 80 2.38 79 0FEV1

2.22 1.18 53 0.51 23 -57FEV1% 74 49 21 -57TLC 4.73 4.03 85RV 1.72 1.64 95RV/TLC% 37 41DLCO

Couldno