Clinical Tests of Respiratory Function (Hodder Arnold Publication) - 3rd edition

446 Pages·2009·12.87 MB·English

by  G J Gibson

Clinical Tests of
Respiratory Function
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Clinical Tests of
Respiratory Function
THIRD EDITION
Professor G. John Gibson, BSc, MD, FRCP, FRCPEd
Consultant Physician, Freeman Hospital and
Professor of Respiratory Medicine,
Newcastle University,
Newcastle upon Tyne, UK
PART OF HACHETTE LIVRE UK
First published in Great Britain in 1984 by Macmillan
Second edition 1996, Chapman & Hall
This third edition published in 2009 by
Hodder Arnold, an imprint of Hodder Education, part of
Hachette Livre UK, 338 Euston Road, London NW1 3BH
http://www.hoddereducation.com
© 2009 G John Gibson
All rights reserved. Apart from any use permitted under UK copyright law,
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disclaimer) every effort has been made to check drug dosages; however it is still
possible that errors have been missed. Furthermore, dosage schedules are constantly
being revised and new side-effects recognized. For these reasons the reader is strongly
urged to consult the drug companies’ printed instructions before administering any
of the drugs recommended in this book.
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ISBN-13 978-0-340-92561-4
1 2 3 4 5 6 7 8 9 10
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Contents
Preface vii
Preface to the first edition ix
PART A The tests and their physiological basis
1 Respiratory mechanics 3
2 Pulmonary gas exchange 53
3 Carbon monoxide diffusing capacity (transfer factor) 76
4 Arterial blood gases and acid–base balance 82
5 Tests of ventilatory control 96
6 Respiratory measurements during sleep 104
7 Exercise tests 117
8 Normal variation 132
PART B Function in respiratory disease
9 Chronic obstructive pulmonary disease and obliterative bronchiolitis 149
10 Bronchiectasis and cystic fibrosis 193
11 Asthma 199
12 Central airway obstruction and bronchial carcinoma 221
13 Respiratory infections and acute respiratory distress syndrome 235
14 Diffuse parenchymal lung disease 242
15 Pulmonary vascular disease 263
16 Diseases of the pleura and chest wall 272
17 Function of the transplanted lung 281
18 Sleep apnoea syndromes 291
PART C Respiratory function in systemic diseases
19 Cardiac disease 307
20 Neuromuscular disease 324
21 Blood disorders 351
22 Renal diseases 359
23 Hepatic and bowel disease 365
vi Contents
24 Metabolic and endocrine disorders 370
25 Rheumatic and connective tissue disorders 384
26 Psychogenic dyspnoea 392
PART D Interpretation of respiratory function tests
27 Use of respiratory function tests 399
Glossary 409
Index 413
Preface
In the 25 years since the first edition of this book, more extensive coverage in this edition. Even in
respiratory function tests have become more inte- traditional areas, such as asthma and chronic air-
grated within the clinical practice of respiratory ways disease, where functional measurements are
medicine,though perhaps not always with the dis- well established, better understanding of patho-
crimination desirable.Technological advances and physiology and improvements in technology have
computerization have brought great benefits in expanded their rational application.
terms of convenience and accuracy, but there is The aims of the book are essentially unchanged –
a downside, with some erosion of technical skills to explain the pathophysiology underlying the most
and less accessible raw measurements.The need to useful tests of respiratory function in disease,at rest,
understand the basis of the tests in order to use during exercise and during sleep; to describe the
them optimally has not diminished. abnormalities seen both in respiratory and non-
A great fillip to the discipline has been the respiratory disease; and to review the value and
increasing recognition of sleep-disordered breathing interpretation of the measurements in clinical prac-
and the explosive expansion of respiratory meas- tice.Many recent references have been added but,
urements during sleep.At the same time,measure- inevitably,the choice is selective and relevant ear-
ments on exercise have become more generally lier references have been retained,not least because
available and also better standardized. Although reviewing the recent literature shows that reinven-
sleep and exercise measurements are both covered tion of the wheel is not uncommon.
more comprehensively in monographs dedicated
specifically to them, their increasing importance GJ Gibson
in respiratory function testing is reflected by Newcastle upon Tyne,2008
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Preface to the first edition
Tests of respiratory function have been available or fluid lavaged from the lung,as well as studies of
for clinical use for about 30 years but they are still pulmonary metabolism and of the way drugs are
not fully integrated in the mainstream of clinical handled by the lung.All these are expanding fields
medicine.I think they are often ill understood and but so far none has generated a widely applicable
therefore frequently misused, or, more impor- clinical test.
tantly, not used when they should be.The main This book is not primarily a laboratory manual
aim of this book is to narrow the divide between with a detailed technical account of the tests,nor
respiratory physiology and the lung function labo- does it give comprehensive normal or reference
ratory on the one hand,and the bedside or outpa- values as these are fully covered elsewhere,notably
tient clinic on the other. To a large extent, the by Cotes.The choice of tests included is a personal
failure to apply the tests appropriately stems from one – I did not set out to cover every conceivable
the misguided feeling that complicated laboratory- test,but I have concentrated on those that I find to
based measurements are needed, when, in fact, be of value in assessing the severity of a functional
simple tests used in the ward or clinic are often of disturbance, in elucidating its mechanism, in dif-
much greater value.To many the jargon and hiero- ferential diagnosis and in following responses to
glyphics of respiratory physiology are undoubt- treatment.I have included a few tests that are of
edly inhibiting and, it must be admitted, doubtful clinical applicability (e.g.the D and V
m c
respiratory physiologists have themselves been to components of the CO diffusing capacity),or are
blame for perpetuating the mystique of their sub- too demanding of technology for widespread use
ject and often for failing to promote a pragmatic (e.g. the multiple inert gas technique of Wagner
approach which can be routinely applied to clini- and West), where these aid the understanding or
cal situations.The more tests used and the more interpretation of simpler tests. I must also admit
indices recorded, the more superficially impres- that occasionally the criterion for inclusion of an
sive (and perhaps the more lucrative) is the report unusual feature or piece of information has been
on an individual patient;the disadvantages of this simply that I find it interesting.In many situations
approach are that it dilutes the clinical relevance the exact pathogenesis of abnormalities of respira-
of the information and may assault the compre- tory function tests is ill understood, but where
hension of its recipient. specific mechanisms are established or likely, I
I hope this book will be of value to respiratory have tried to explain these, with the philosophy
physicians in practice and in training,and particu- that sensible application of the tests is more likely
larly to those involved in the interpretation of the to result from understanding or from a question-
commonly performed tests of respiratory func- ing attitude than from ignorance or unwarranted
tion. The tests described are conventional meas- assumptions.
urements of function of the ‘whole organ’;tests of
respiratory function in the broadest sense might GJ Gibson
also include biochemical and subcellular tech- Newcastle upon Tyne,1983
niques applied to bronchial secretions,lung tissue