The inventor of spirometer John Hutchinson 1846 Ventilation

The inventor of spirometer: John Hutchinson (1846)

Ventilation and V/Q ratio

Branching of the airways

Static lung volumes IC

Slow (SVC) and forced (FVC) vital capacity in health and disease

Elastic forces and airway diameter

Antropometric data determine reference values -Age -Height -Sex - Race

Spirogram and flow-volume loop

Asthma - reversible airway obstruction spirogram FVC: 2. 4 (73 ref%) – 3. 1 (92 ref%) FEV 1: 1. 0 (36 ref%) – 1. 5 (52 ref%) FEV 1/FVC: 42% - 49% F-V loop

COPD = postbronchodilator FEV 1/FVC<70% (irreversible airway obstruction

Lung fibrosis FVC: 75 ref% FEV 1: 78 ref% FEV 1/FVC: 87% TLC: 63 ref% RV: 57 ref% DLCO: 34 ref%

Heart failure FVC: 55 ref% FEV 1: 49 ref% FEV 1/FVC: 74%

Typical spirograms and flow-volume loops

Etiology of obstructive and restrictive ventilatory disorders

Pathophysiology of the variable lesion of the major (proximal) airways

Typical F-V loops in cases of lesions of the major airways

Flow-volume loops A: normal, B: obstructive, C: restrictive

Inhalative provocation test with metacholin

Asthma – reversible obtruction healthy asthmatic

COPD

COPD (emphysema!!!)

Lung fibrosis

Use of spacer with MDI

How to measure FRC (RV, TLC) ? • Nitrogen washout method • Inert gas dilution technique • Plethysmography

Resistance

Volume dependence of airway resistance (Raw) RV SRaw (cm. H 2 O/L/sec) 4 3 2 1 TLC 0 2 4 6 Lung Volume (liters) 8

Compliance

Diffusion capacity (DLCO, DLCO/VA, Tco, Kco)

Arterial Blood Gas

Respiratory and metabolic shifts chronic acute chronic

Exercise tests in lung diseases 1. Exercise-induced asthma (EIA) - FEV 1 2. Interstitial lung disease (ILD) - SAT 3. Exercise tolerance in rehabilitation (COPD) cardiopulmonary exercise (CPX). Important variables: - work rate (watts), Sp. O 2, ABG - VO 2, VCO 2, RQ, VE - lactate threshold (LT) - breathing reserve (1 -VEmax/MVV) - heart rate reserve (1 -HRmax/220 -age)

Mechanism of exercise-induced Hypoxaemia (decreased contact time)

Noninvasive determination of lactate threshold by the V(entilatory)-slope method