臨 床 肺 功 能 檢 查 內科住院醫師教學

郭許達 醫師

馬偕醫院 胸腔內科 2018/3/13

Indications for Spirometry Vol 26 No 2 European Respiratory Journal

Diagnostic

To evaluate symptoms, signs, or abnormal laboratory tests

To measure the effect of disease on pulmonary function

To screen individuals at risk of having pulmonary disease

To assess pre-operative risk

To assess prognosis

To assess health status before beginning strenuous physical activity programmes

Monitoring

To assess therapeutic intervention

To describe the course of diseases that affect lung function

To monitor people exposed to injurious agents

To monitor for adverse reactions to drugs with known pulmonary toxicity

Disability/Impairment evaluations

To assess patients as part of a rehabilitation programme

To assess risk as part of an insurance evaluation

To assess individuals for legal reasons

Public health

Epidermiological surveys; Derivation of reference equations; Clinical research

Obstructive defect Moderate stage

Upper Airway Obstruction

Extra-Thoracic UAO Intra-Thoracic UAO

Expiration

FEF/FIF > 1 FEF/FIF >1 FEF/FIF< 1

Upper Airway Obstruction, UAO

【Ｓ】 主訴: 呼吸喘 3~4天 PI : cough recently

chest pain -; SOB + ; DOE - 過去病史: Asthma 【Ｏ】 意識: GCS(E4M6V5) ill-looking 外觀: MD, NOT EMACIATED 瞳孔: OD(+) 光反射 2mm OS(+) 光反射 2mm 眼睛: not pale, anicteric 頸部: supple, no meningeal sign, JVE(-) 胸部: Symmetrical expansion, wheezing (+), 心臟: RHB, no murmur 腹部: Soft, no tenderness, no peritoneal sign 四肢: not deformed, no pitting edema 神經學: EOM: no limitation, no cerebellar sign

陳X蒔 F. age 44 ＃850569

Chest OPD

Goiter for over 10 yrs, euthyroid state last yr. Denied asthma or allergic

Intra-thoracic UAO

#850669 陳X蒔

# 35114608 葉X順 Age 59; M. 門診 【Ｓ】

Cough with scanty sputum for several months, no SOB Hoarseness Pulmonary TB treated in 2004 【Ｏ】

Throat: injected BS: bilateral coarse and rhonchi Chest x-ray: fibrotic lesion on both upper, stationary

Sputum AFB smear : negative

Extra-thoracic UAO

A 78 y/o female had subtotal thyroidectomy for

thyroid tumor 38 years ago.

At OPD presenting with right neck mass with

neck pain and headache for one month.

There was no hoarseness but with dyspnea.

Extra-thoracic UAO

# 47165269 彭xx英

72 yrs old male

• DOE and rhinorrhea recently

• Hoarseness for 6 months. R’t vocal mass was noted at ENT OPD.

• BS: bilateral coarse and rhonchi, stridor (+)

# 47135431, 蕭X森, M , Age 66

Dyspnea and productive cough treated as COPD before.

Dyspnea after walking 50 meters. Wheezes audible especially at night. Ex-smoker: quit for a few months. Breath sound: bilateral middle to lower lung

end-expiratory wheezing COPD ? Asthma ?

# 47135431, 蕭X森， Male ,age 66

21 yr old male

Pectus excavatum

s/p Nuss operation

#5965636 莊X賢, F, age 56

The provocative concentration of methacholine challenge for a 20 percent fall in the FEV1 is 5.046mg/ml, borderline bronchial hyper-responsiveness. Ref:ATS guideline, Am J Respir Crit Care Med, 2000 PC20(mg/ml) > 16 -->Normal ; 4.0-l 6 -->Borderline BHR; 1.0-4.0 -->Mild BHR (positive test) ; < 1.0 -->Moderate to severe BHR

4

1

3

5

2

< 70%

>12%,200ml

<1

< 80%

<80%,<50%,

1

2 3

4

5

Bedside Lung Function Examination

1. Peak flowmeter

2. Incentive spirometer

3. Tidal volume and minute ventilation, Haloscale

4. Pimax

5. Pulse oximeter

6. Lung compliance, thoracic

肺功能教學課後評估 (答案可多選)

1.The indication of the pulmonary function test is:

(a) Diagnosis of dyspnea

(b) Follow up the course of the lung disorder

(c) Monitoring the therapeutic response

(d) Pre-operation lung evaluation

2. Factors influence the result of the lung function test is:

(a) Technician’s guidance

(b) Patient’s cooperation

(c) Equipment calibration

3. The interpretation of the following lung function data is

Pred actual % of predict FVC (L) 5 5.0 100 FEV1(L) 4.0 3.0 75 FEV1/FVC 80 60 TLC (L) 6.5 6 92

(a) Obstructive lung disorder; (b) Restrictive lung disorder; (c) Mixed obstructive and restrictive disorder

4. The patient has dyspnea The interpretation of his lung function test is :

Pred PreRx % pred PostRx % change

FVC (L) 5.0 5.0 100 5.0 0 FEV1(L) 4.0 3.0 75 4.0 33 FEV1/FVC 80 60 TLC (L) 6.5 6.0 92 (a) Restricted lung impairment (b) Obstructive impairment (c) No significant bronchodilator response (d) Significant bronchodilator response

5. An asthmatic patient in under regular treatment, his best peak flow is 400 L/m.

In recent one week he had difficult to breathing and measurement of peak flow is 200 L/m.

The management of this situation, is according to which one of the suggestion?

(a)Green zone

(b) Yellow zone

(c) Red zone

40747466 丘 x 娜 Pectus excavatum

# 3602370 張X羽 F, age 62

# 3602370

張X羽F, age 62