Pneumonic Function Tests

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Utilization of PFT\'s. Assessing breathlessnessInitial assessment of patient with known respiratory diseaseFollowing the course of a respiratory diseasePre-agent assessmentDisability evaluationScreening of subclinical sickness. Impediments of PFT\'s. Patient\'s participation and an educated professional are requiredMeasures the lung and mid-section as a unitEvaluates illness at one and only point in timeErrors in

Presentation Transcript

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Aspiratory Function Tests Ghassan Jamaleddine, M.D. American University of Beirut

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Use of PFT's Evaluating windedness Initial assessment of patient with known respiratory ailment Following the course of a respiratory ailment Pre-agent appraisal Disability assessment Screening of subclinical ailment

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Disadvantages of PFT's Patient's participation and an educated professional are required Measures the lung and trunk as a unit Evaluates ailment at just a single point in time Errors in projects of PC driven computerized hardware

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Routine PFT's Spirometry with or without Flow Volume circle Static lung volumes Single Breath Diffusing Capacity

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Spirometry Forced fundamental limit Forced Expiratory Volume in one moment (FEV1) Percent Expired (FEV1/FVC or FEV1%) Forced Mid-Expiratory Flow (FEF 25-75) or Maximal Mid-Expiratory Flow (MMEF or MMF) Peak or Maximal Expiratory Flow Rate (PEF or MEFR)

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Obstructive Vent deformity FVC decreased or Normal FEV1 lessened FEV1/FVC is diminished Example: Asthma, COPD Restrictive Vent imperfection FVC lessened FEV1 ordinary or diminished FEV1/FVC is expanded Example: pneumonic fibrosis, pleural radiation, neuromuscular Pattern of imperfections seen on PFT's

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P 1 V1 = P2 (V1-Δ V)

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Lung Volumes Functional Residual Capacity Expiratory Reserve Volume Residual Volume Inspiratory Capacity Total Lung Capacity Vital Capacity

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FLOW VOLUME LOOP

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Diffusion Transfer of a gas over a tissue sheet, administered by Fick's law Rate of Transfer = A D x P/T

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Diffusion Capacity (estimation) A D x (P1-P2) T AD/T = Diffusion constante Rate of exchange (CO) = Vco = Dlco x (P1-P2) Dlco = Vco/PA –Pa = Vco/PA 25 ml/min/mmHg

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Diffusing Capacity Influenced by: Changes in alveolar-fine layer Pulmonary dissemination Ventilation perfusion coordinating Hemoglobin fixation

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Diffusion Capacity Very critical in Interstitial lung illness Drug instigated lung damage Reduced in Emphysema due to demolition of alveolar units

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PFT Patterns in Disease PFT results are best translated with learning of the patients history, physical exam and infrequently trunk X-beam.

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Case 1 14 year old kid came to ER with expanding shortness of breath History of asthma since age of 2-3 Maintained on ICS and Beta2 agonists Followed by Family doctor, past year visit assaults, a few courses of anti-infection agents and systemic corticosteroids

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Case 1 (cont'd) In ER began on iv steroids and breathed in Beta 2 agonists, no change, conceded No history of atopy, no nasal nor GI side effects, no family history of asthma Exam: diminish breath sounds Admitted

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Case 1 (cont'd) CXR, CBC, science non uncovering After 2 days of treatment with steroids and breathed in bronchodilators there was no change in indications Noticed swoon voice and tachypnea on negligible practice PFT acquired

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Case PFT's FVC 93%, FEV1 45%, FEV1/FVC 41% TLC 90%, RV 90%, DLCO 100% ?????

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Case 1(cont'd) FOB: subglottic stenosis (? Innate) Tracheostomy took after by reconstructive surgery Total recuperation, no more asthma treatment

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Case 2 32 year old man gave 2 months history of expanding shortness of breath Married, non-smoker, bank representative, no history of asthma No different side effects Shortness of breath expanding before introduction Seen by numerous doctors, given various anti-toxins, bronchodilators, aminophylline

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Case 2 (Cont'd) Exam: BP 120/80, RR 18, P100, BMI 29, afebrile, trunk: clear… rest of exam was typical ER: ABG's ordinary, CXR: ordinary, CT angio: typical, neuro counsel (individual): no neuro issue Patient consoled by the group

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Case 2 (cont'd) Spirometry acquired: FVC half FEV1 55% FEV1/FVC 80% MVV 20% ????

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Case 2 (cont'd) Neurology going to reconsulted EMG: Myasthenia Gravis Diagnosis suspected from FVC and MVV Neuromuscular ailment

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Case 3 A 60 year old man with history of ex-smoking, history of occasional colds, conceded for hernia operation Pulmonary counseled for pre-operation freedom as a result of heftiness The patient denied aspiratory protests, however his better half unveiled that he has an unending hack

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Case 3 Obstructed imperfection

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Case 3

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Pre-agent screening Patients with known pneumonic disease or side effects Overweight Patients experiencing surgery in the trunk or close to the stomach

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Case 4 A 65 year old man non-smoker, legal counselor, conceded for elective Lap Chole. Reports long history of gentle hack, and dyspnea on effort Physical exam: bibasilar dry crackles (velcrow), clubbing of the fingers

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Case 4 Restricted deformity

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Case 4 TLC 60% RV 40% DLCO 40% HRCT

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Case 4

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Case 5 68 year old man with dynamic dyspnea of one year span, ex-smoker, no hack, no wheezing, no orthopnea… History of CAD, SVT post angioplasty on various medicine EF% 55 Meds: Plavix, beta one blocker, diuretics, cordarone, ARB,

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Case 5 FVC half FEV1 55% FEV1/FVC 85% TLC 70% DLCO half

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Case 5 PFT's: Major drop in FVC and DLCO contrasted with the PFT done 2 years before HRCT of trunk: Increased markings over the bases, with territories of expanded improvement… . Reliable with Amiodarone harmfulness

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Follow up patients Connective Tissue illnesses (e.g. scleroderma) Patients on Therapy that may influence the pneumonic framework Neuromuscular illnesses

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Follow up Patients with Lung Diseases Obstructive aviation route sicknesses Interstitial lung ailments Sarcoidosis IPF ILD (CTD)

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Conclusion PFT's Spirometry Lung volumes DLCO

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Conclusion: Indications Evaluating shortness of breath Initial assessment of patient with known respiratory malady Following the course of a respiratory ailment Pre-agent appraisal Disability assessment Screening of subclinical infection

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