Making Sense of Lung Function Tests PDF
Preview Making Sense of Lung Function Tests
MAKING SENSE of Lung Function Tests Second edition A hands-on guide MAKING SENSE of Lung Function Tests Second edition A hands-on guide Jonathan Dakin, MD FRCP BSc Hons Consultant Respiratory Physician Royal Surrey County Hospital NHS Foundation Trust Surrey, UK Honorary Consultant Respiratory Physician Portsmouth Hospitals NHS Trust Hampshire, UK Mark Mottershaw, BSc Hons MSc Chief Respiratory Physiologist Queen Alexandra Hospital Portsmouth Hospitals NHS Trust Hampshire, UK Elena Kourteli, FRCA Consultant Anaesthetist St George’s University Hospitals Foundation NHS Trust London, UK CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2017 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-4822-4968-2 (Paperback) This book contains information obtained from authentic and highly regarded sources. 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Ἱπποκράτης Life is short, science is long; opportunity is elusive, experiment is dangerous, judgement is difficult. Hippocrates Contents Preface xv Acknowledgement xv Abbreviations xvii 1 Expressions of normality 1 PART 1 TESTS OF AIRWAY FUNCTION AND MECHANICAL PROPERTIES 5 2 Peak expiratory flow 7 Introduction 7 Test description and technique 7 Pitfalls 7 Physiology of test 8 Normal values 8 Peak flow variability in the diagnosis of asthma 8 Assessment and management of asthma 11 Pitfall 12 3 Spirometry and the flow–volume loop 13 Introduction 13 Measured indices and key definitions 13 Test description and technique 13 Physiology of tests 16 Restrictive and obstructive defects 16 Restrictive defects 16 Obstructive defects 18 Maximum expiratory flows 18 Normal values 20 Assessment of severity of obstruction 21 Mid-expiratory flows 22 vii viii Contents FVC versus VC 23 Patterns of abnormality 23 Obstructive spirometry 23 Restrictive spirometry 25 Reduction of FEV and FVC 27 1 Mixed obstructive/restrictive defect 27 Non-specific ventilatory defect 28 Large airways obstruction 29 Fixed upper airway obstruction 29 Variable extrathoracic obstruction 29 Variable intrathoracic obstruction 31 Clinical pearls 31 4 Airway responsiveness 35 Introduction 35 Test physiology 35 Test descriptions 36 Reversibility 36 Challenge testing 37 Interpretation of results 37 Reversibility 37 Challenge testing 38 5 Fractional concentration of expired nitric oxide 41 Introduction 41 Test description/technique 41 Physiology of test 42 Normal values and interpretation 43 Specific considerations 44 6 Gas transfer 45 Introduction 45 Measured indices/key definitions 45 Alveolar volume 46 K 46 CO Test description 47 Physiology of gas exchange 48 Normal values 48 Patterns of abnormality 49 Incomplete lung expansion 49 Discrete loss of lung units 51 Diffuse loss of lung units 52 Contents ix Pulmonary emphysema 52 Pulmonary vascular disease 53 Causes of increased gas transfer 54 Clinical pearls 54 Interstitial lung disease 54 Obstructive disease 55 Acute disease 56 7 Static lung volumes and lung volume subdivisions 57 Introduction 57 Measured indices/key definitions 57 Test descriptions/techniques 59 Helium dilution 59 Nitrogen washout 61 Whole-body plethysmography 61 Comparison of methods 63 Physiology of lung volumes 64 Total lung capacity 64 Residual volume 64 Functional residual capacity 64 Closing capacity 65 Normal values 65 Patterns of abnormality 66 Relationship between VC and TLC 67 Obstructive lung disease 67 Interstitial lung disease 67 Miscellaneous 68 Specific considerations 68 Anaesthesia 68 FRC in patients receiving ventilatory support: PEEP and CPAP 68 Clinical pearls 70 8 Airway resistance 73 Introduction 73 Physiology of airway resistance tests 74 Plethysmography technique 75 Test description/technique 75 Measured indices/key definitions 76 Normal values 76 Patterns of abnormality 76
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