PFT สมาคมอุรเวชชแหงประเทศไทย

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. Guidelines for Pulmonary Function Tests

1. Spirometry

1.

1.11.21.3

2. 2.12.22.32.4

3. spirometer3.1Volume-displacement spirometers3.2Flow sensing spirometers3.3Portable devices3.4 spirometer

4

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5.25.35.4

6. 6.16.2

7. Appendices7.1 1 spirometer7.2 2 Conversion factors from ATPS to BTPS7.3 3 (predicted values)

7.4 4. (predicted values)

, 8. Further readings

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1. 1.1 (Pulmonary Function Tests) , , ,

1. (maximal effort)

2.

(technician)

3.

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1.3

1. (Spirometry)

2. (Static lung volumes) spirometry residualvolume, functional residual capacity, total lung capacity closed circuit helium dilution body plethysmography

3. (Diffusing capacity for carbonmonoxide: DL

CO

) 2 single breath, steady state fractionalCO-uptake DLCO DLCO

DLCO interstitial lungdiseases

4. (Nonspecific bronchialhyperresponsiveness) histamine methacholine

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6. (Respiratory center sensitivity)

7.

8. (Cardiopulmonary exercise testing)

spirometry spirometry

2.

2.1 spirometry

spirometer spirogram ( 1)

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FVC SVC FVC SVC

- FEV1 (forced expiratory volume in one second)

FEV1 BTPS FEV1

- FEV1/FVC FEV1 FVC 100 percent FEV1 (%FEV1)

- FEF 25 75% (forced expiratory flow at 25 75% of FVC) FVC BTPS 2 . reproduce FEV1 FEV1 FVC

- PEF (peak expiratory flow) BTPS PEF Wright peak flow meter peak flow meter mini Wright

flow-volumecurve ( 2) flow-volume loop flow-volume curve reproducible ( 3) flow volume curve

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1. ,

2. 3.

4.

2.2.2 1.

interstitial lung disease

2. , interstitial lungdisease, neuromuscular disease Guillain-Barre syndrome

3.

4. amiodarone2.2.3

2.2.4

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5. 6. 7. 8. ()9.

2.4

1. 2. , 3. 4.

5.

6. 7. 8.

3. Spirometerspirometer 2 3.1 Volume-displacement spirometers

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(disinfect)

PEF

3.2 Flow sensing spirometers microprocessor

spirometer flow sensing spirometer sensor

(flow) flow sensor sensor :

- Fleischpneumotach orifice

- hot wire pneumotach- turbine

pneumotach

spirometer ,

,

,

spirogram flow-volume curve

spirometer (stability) sensor

calibrate BTPS () calibration sensor

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3.4 spirometerspirometer- American

Thoracic Society (ATS), European Respiratory Society (ERS) - - - calibrate - - maintenance - - sensor disposable -

- , calibrate ,

-

- 4. 4.1 spirometry

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2 agonist anticholinergic 6-8

2 agonist , salmeterol, theophylline 12 theophylline 24

2 agonist 15

, , , 2 2

, , arm span 2

sternal notch 2

4.1.2

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mouthpiece mouthpiece

( residual volume)

flow volume loop

3 8

acceptability & reproducibility

4.2 Acceptability criteria

1.

-

extrapolated volume

5%

FVC

0.15 spirometer2. -

6 plateau 1 6 plateau 1 ,

mouthpiece ( 7,8)

4.3 Reproducibiity criteria

acceptability criteria 3

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curve 4.2 acceptability criteria

reproducibility criteria 4.3 reproducibility criteria 1. The best FVC FVC 2. The best FEV1 FEV13. FEF 25-75% the best test curve

FEV1 FVC FEV1 FVC

FEV1 FVC

4.5 4.5.1

FVC - - mouthpiece- - - - mouthpiece- glottis-

4.5.2

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spirometry

,,

1. 2. Knudson , Quanjer

10-153. Lam

3 (caucasian) , 10-15

5.2

FEV / FVC

FVC

Low Normal or Increased

NormalLow

Obstruction Mixed

i h l 2 i t

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spirometry obstructive defect restrictive defect FEV1,FVC FEV1/FVC%

Obstructive defect asthma,COPD FEV1 FEV1/FVC% FVC

Restrictive defect interstitial lung disease, myasthenia gravis,

kyphoscoliosis FEV1 FVC FEV1/FVC%

5.3

FVC

(%

)

FEV1

(%

)

FEV1/FVC

(%)

FEF25-75%

(%

)

Normal

Mild

Moderate

Severe

>80

66-80

50-65

80

66-80

50-65

70+

60-70

45-59

65

50-65

35-49

75%

flow-volume curve

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5-10 1-10 1

1 puff 15 (post-bronchodilator spirometry)

Percent reversible = FEV1 - FEV1 100FEV1

Percent reversible 12% FEV1 200 .. reversible

6. spirometer

spirometer American Thoracic Society (ATS) spirometer

6.1

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1. 2. 3.

6.2.1

spirometer

1. 2. calibration 3. 4.

5. calibrate

6

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1) Calibration calibrate

calibrate

calibrate calibrate

calibrate

Calibrate calibrate 4 ,

calibrate

spirometer

2) calibrate spirometer1. 2. 3.

4 calibrate 3

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7. 3 calibrate 4-5

3) calibrate spirometer

3 1 %

4)

spirometer

6.2.3

spirometer universal precautions

mouth piece , , HIV ,

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2. mouth piece

3. mouth piece filter

4. disinfection sterilization

5. spirometer

6.

7.

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7. Appendices

1 spirometer

Test Range/Accuracy

(BTPS)

Flow Range

(L/s)

Time(s) Resistance and

Banck Pressure

Test Signal

VC

FVC

FEVt

Time zero

PEF

FEF25-75%

V

MVV

0.5 to 8 L + 3% of reading or + 0.050L.

whichever is greater





The time point from which all FEVt

measurements are taken

Accuracy:+10% of reading or +0.400L/s,


Precision:+5% of reading or +0.200L/s,


7.0 L/s +5% of reading or +0.200L/s,


+14.0 L/s +5% of reading or +0.200L/s,


250 L/min at TV of 2 L within +10% of

reading or +15% L/min.


Zero to 14

Zero to 14

Zero to 14

Zero to 14

+14

Zero to 14

+14

+3%

30

15

1

15

15

12 to 15

Less than 1.5

cmH20/L/s

Less than 1.5

cmH20/L/s

Back extrapolation

Same as FEV1

Same as FEV1

Same as FEV1

Pressure less than

+10 cm H20 at

2-L TV at 2.0 Hz

3-L Cal Syringe

24 Standard

waveforms

3-L Cal Syringe

24 standard

waveforms

26 flow standard

waveforms

24 Standard

waveforms

Proof from

manufacture

Sine wave pump

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2. Conversion factors from ATPS to BTPS

SPIROMETER TEMPERATURE SATURATED WATER VAPOUR BTPS FACTOR

(Celsius) (mmHg)

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

14.5

15.5

16.5

17.5

18.7

19.8

21.1

22.4

23.8

25.2

26.7

28.3

30.0

31.8

33.7

35.7

1.118

1.113

1.108

1.102

1.096

1.091

1.085

1.080

1.075

1.069

1.063

1.057

10.51

1.045

1.039

1.032

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3.

PARAMETERS EQUATIONS* R2

SEE

FVC (L) male -2.601+0.122A-0.00046A2+0.00023H

2-0.00061AH 0.67 0.4341

female -5.914+0.088A+0.056H -0.0003A2-0.0005AH 0.62 0.3238

FEV1 (L) male -7.697+0.123A+0.067H -0.00034A2-0.0007AH 0.70 0.3716

female -10.6+0.085A+0.12H -0.00019A2-0.00022H

2-0.00056AH 0.68 0.2759

FEF25-75%

(L/s) male -19.049+0.201A+0.207H-0.00042A2-0.00039H2-0.0012AH 0.42 0.8828

female -21.528+0.11A+0.272H -0.00017A2-0.0007H

2-0.00082AH 0.46 0.6642

PEF (L/s) male -16.859+0.307A+0.141H-0.0018A2-0.001AH 0.44 1.5437

female -31.355+0.162A+0.391H -0.00084A2-0.00099H

2-0.00072AH 0.29 1.1175

FEV1/FVC (%) male 19.362+0.49A+0.829H-0.0023H2-0.0041AH 0.24 5.3638

female 83.126+0.243A+0.084H+0.002A

2

-0.0036AH 0.22 4.9857

* A= age (y); H= height (cm.)

Source: Dejsomritrutai W, Nana A, Maranetra N, et al. Reference spirometric values for healthy

lifetime nonsmokers in Thailand. J Med Assoc Thai 2000; 83: 457-466.

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1. Spirogram

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2 . Flow volume curve

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3. Flow - volume loop upper airway obstruction

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4. Water sealed spirometer

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5. Dry rolling seal spirometer

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6. Bellow spirometer

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7. acceptable curve

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8. unacceptable curve

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8. Further readings1. American Thoracic Society (ATS). Statement on standardisation of spirometry 1994

update . Am J Respir Crit Care Med 1995;152:1107-39.

2. Quanjer PhH, Tammeling GJ, Cotes JE, et al. Standardized lung function testing. EurRespir J 1993;6(suppl 16):1-100.

3. Crapo RO. Pulmonary function testing. N Engl J Med 1994;331:25-30.4. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal

expiratory flow volume curve. Normal standards variability and effect of age. Am Rev

Respir Dis 1976;113: 587-600.

5. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximalexpiratory flow volume curve with growth and aging. Am Rev Respir Dis

1983;127:725-34.

6. Lam KK, Pang SC, Allan WGL, et al. A survey of ventilatory capacity in Chinesesubjects in Hong Kong. Ann Hum Biol 1982;9:459-72.

7. Dejsomritrutai W, Nana A, Maranetra N, et al. Reference spirometric values forhealthy life time nonsmokers in Thailand. J Med Assoc Thai 2000;83:457-66.

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4. (predicted values) , FVC(L): Male

Height (cm)Age (y)

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

4045

50

55

60

65

70

75

2.13

2.42

2.63

2.76

2.82

2.84

2.812.75

2.67

2.59

2.51

2.44

2.4

2.4

2.37

2.65

2.85

2.97

3.02

3.02

2.992.92

2.83

2.74

2.65

2.58

2.53

2.51

2.62

2.9

3.08

3.19

3.23

3.23

3.183.1

3.01

2.9

2.8

2.72

2.66

2.64

2.9

3.16

3.33

3.43

3.46

3.45

3.393.3

3.19

3.08

2.97

2.87

2.8

2.78

3.18

3.43

3.6

3.68

3.71

3.68

3.613.51

3.39

3.26

3.14

3.03

2.95

2.91

3.49

3.73

3.9

3.96

3.97

3.93

3.843.73

3.6

3.46

3.32

3.2

3.11

3.06

3.82

4.04

4.18

4.24

4.24

4.19

4.093.97

3.82

3.67

3.52

3.39

3.28

3.21

4.17

4.38

4.5

4.55

4.53

4.46

4.364.22

4.06

3.89

3.73

3.58

3.46

3.38

4.54

4.73

4.84

4.87

4.84

4.76

4.644.48

4.31

4.13

3.95

3.79

3.66

3.56

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FEV1(L): Male

HeightAge

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

45

50

55

60

65

70

75

1.83

2.1

2.28

2.38

2.41

2.38

2.3

2.17

2.02

1.84

1.65

1.45

1.27

1.1

2.06

2.31

2.47

2.55

2.56

2.52

2.43

2.29

2.13

1.95

1.76

1.56

1.38

1.22

2.31

2.53

2.67

2.73

2.73

2.67

2.56

2.42

2.25

2.06

1.87

1.67

1.49

1.34

2.58

2.77

2.88

2.92

2.9

2.82

2.7

2.54

2.37

2.17

1.98

1.78

1.61

1.45

2.86

3.03

3.11

3.12

3.08

2.98

2.85

2.68

2.49

2.29

2.09

1.89

1.72

1.57

3.17

3.3

3.35

3.34

3.27

3.15

3

2.82

2.62

2.41

2.2

2

1.83

1.68

3.49

3.58

3.6

3.57

3.47

3.33

3.16

2.96

2.75

2.53

2.31

2.11

1.93

1.79

3.83

3.89

3.88

3.81

3.68

3.52

3.32

3.11

2.88

2.65

2.42

2.22

2.04

1.89

4.19

4.21

4.16

4.06

3.91

3.72

3.5

3.26

3.02

2.77

2.54

2.32

2.14

1.99

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FEV1/FVC (%): Male

Height (cm)Age (y)

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

4550

55

60

65

70

75

88.24

88.75

89.08

89.24

89.23

89.04

88.67

88.1687.45

86.57

85.52

84.3

82.91

81.34

88.79

89.02

89.11

89.08

88.92

88.64

88.23

87.6987.02

86.23

85.3

84.26

83.08

81.78

89.38

89.29

89.13

88.89

88.56

88.16

87.68

87.1286.48

85.75

84.95

84.07

83.1

82.06

90

89.58

89.14

88.66

88.15

87.61

87.04

86.4485.81

85.15

84.45

83.73

82.97

82.18

90.66

89.88

89.13

88.4

87.68

86.99

86.31

85.6685.02

84.4

83.8

83.22

82.66

82.12

91.35

90.2

89.11

88.1

87.15

86.28

85.48

84.7584.09

83.5

82.99

82.54

82.17

81.87

92.09

90.52

89.08

87.76

86.56

85.49

84.54

83.7283.03

82.46

82.01

81.69

81.49

81.42

92.87

90.86

89.03

87.38

85.9

84.61

83.5

82.5781.81

81.24

80.85

80.64

80.6

80.75

93.69

91.21

88.96

86.95

85.18

83.64

82.34

81.2880.45

79.86

79.5

79.39

79.51

79.86

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FEF25-75% (L/sec): Male

HeightAge

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

4550

55

60

65

70

75

2.32

2.78

3.11

3.32

3.41

3.42

3.33

3.182.97

2.72

2.43

2.13

1.82

1.51

2.63

3.03

3.31

3.48

3.54

3.52

3.42

3.263.05

2.81

2.54

2.26

1.98

1.72

2.96

3.3

3.53

3.64

3.67

3.62

3.5

3.333.12

2.88

2.63

2.37

2.13

1.91

3.32

3.59

3.75

3.82

3.8

3.72

3.58

3.393.18

2.94

2.7

2.47

2.25

2.07

3.7

3.9

3.99

4

3.94

3.82

3.65

3.443.22

2.98

2.75

2.54

2.36

2.21

4.11

4.22

4.24

4.19

4.08

3.92

3.72

3.493.25

3.01

2.79

2.59

2.44

2.33

4.53

4.56

4.51

4.39

4.22

4.01

3.78

3.523.27

3.03

2.81

2.62

2.49

2.42

4.99

4.92

4.79

4.6

4.37

4.11

3.83

3.553.27

3.02

2.8

2.63

2.52

2.48

5.47

5.3

5.08

4.82

4.51

4.2

3.88

3.563.26

3

2.78

2.61

2.52

2.51

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PEF (L/min): Male

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

4550

55

60

65

70

75

249

282

342

386.4

417

435

442.2

440.4432

417.6

399

379.2

358.2

338.4

282

342

386.4

417

435

442.2

440.4

432417.6

399

379.2

358.2

338.4

321.6

315

374.4

418.2

447

464.4

470.4

468

458.4443.4

424.8

404.4

384

364.8

394.2

348

406.8

449.4

477.6

493.8

499.2

495.6

484.8469.2

450

429

408.6

390.6

375.6

381

438.6

480.3

507.6

522.6

526.8

522

510.6493.8

474

453

432.6

414.6

400.8

414

471

511.8

538.2

551.4

554.4

548.4

535.8518.4

498

476.4

455.4

438

424.8

446.4

502.8

543

567.6

580.2

582

574.8

561541.8

520.8

498.6

477.6

459.6

447

479.4

535.2

573.6

597.6

608.4

609

600.6

585565.2

543

519.6

498.6

480.6

468

512.4

567

604.8

627

637.2

635.4

625.8

609588

564

540

518.4

500.4

487.8

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FVC(L): Female

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

4550

55

60

65

70

75

1.98

2.16

2.28

2.35

2.37

2.36

2.31

2.262.19

2.12

2.06

2.02

2

2.02

2.19

2.37

2.48

2.54

2.56

2.54

2.49

2.432.35

2.76

2.21

2.16

2.14

2.16

2.4

2.57

2.68

2.73

2.74

2.72

2.66

2.592.51

2.43

2.36

2.3

2.28

2.28

2.61

2.78

2.88

2.92

2.93

2.89

2.83

2.752.66

2.58

2.5

2.44

2.4

2.4

2.82

2.98

3.07

3.11

3.11

3.07

3

2.912.82

2.72

2.63

2.56

2.52

2.52

3.03

3.18

3.27

3.3

3.29

3.24

3.16

3.072.96

2.86

2.76

2.69

2.64

2.63

2.24

3.38

3.46

3.48

3.46

3.4

3.32

3.213.1

3

2.89

2.8

2.75

2.72

3.45

3.58

3.65

3.66

3.63

3.56

3.47

3.363.24

3.12

3.01

2.91

2.84

2.82

3.65

3.78

3.83

3.84

3.8

3.72

3.62

3.53.37

3.24

3.12

3.01

2.94

2.9

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FEV1 (L): Female

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

45

50

55

60

65

70

75

1.79

1.96

2.07

2.12

2.13

2.1

2.04

1.95

1.86

1.76

1.66

1.57

1.5

1.46

1.99

2.14

2.23

2.26

2.26

2.22

2.14

2.06

1.96

1.85

1.76

1.67

1.61

1.58

2.2

2.33

2.4

2.42

2.39

2.34

2.26

2.16

2.06

1.95

1.86

1.78

1.72

1.7

2.44

2.53

2.58

2.58

2.54

2.47

2.38

2.27

2.16

2.05

1.96

1.88

1.83

1.82

2.68

2.75

2.77

2.75

2.69

2.6

2.5

2.38

2.26

2.15

2.06

1.98

1.94

1.94

2.94

2.98

2.97

2.92

2.85

2.74

2.62

2.5

2.37

2.26

2.16

2.08

2.05

2.05

3.22

3.22

3.19

3.11

3.01

2.89

2.76

2.62

2.48

2.36

2.26

2.18

2.15

2.16

3.51

3.48

3.42

3.31

3.19

3.04

2.89

2.74

2.59

2.46

2.35

2.28

2.24

2.26

3.82

3.76

3.65

3.52

3.37

3.2

3.03

2.86

2.7

2.56

2.45

2.37

2.34

2.36

7/22/2019 PFT

40/42

FEV1/FVC (%): Female

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

45

50

55

60

65

70

75

91.79

91.14

90.52

89.91

89.33

88.76

88.21

87.68

87.18

86.69

86.22

85.77

85.34

84.92

92.38.

91.47

90.61

89.81

89.06

88.38

87.45

87.17

86.66

86.2

85.8

85.46

85.17

84.94

90.02

91.8

90.69

89.68

88.76

87.93

87.2

86.57

86.04

85.6

85.25

85

84.86

84.8

93.69

92.16

90.17

89.52

88.4

87.42

86.58

85.87

85.3

84.86

84.57

87.41

84.38

84.5

94.4

92.54

90.84

89.33

88

86.84

85.87

85.07

84.44

84

83.74

83.66

83.75

84.02

95.16

92.93

90.91

89.12

87.54

86.19

85.06

84.16

83.47

83

82.76

82.74

82.94

83.36

95.97

93.34

90.97

88.87

87.04

85.47

84.17

83.13

82.36

81.86

81.62

81.65

81.94

82.5

96.82

93.77

91.02

88.6

86.48

84.67

83.18

82

81.12

80.56

80.32

80.38

80.75

81.44

97.72

94.21

91.07

88.29

85.86

83.79

82.08

80.73

79.74

79.11

78.83

78.92

79.36

80.16

7/22/2019 PFT

41/42

FEF25-75% (L/sec) : Female

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

45

50

55

60

65

70

75

2.72

2.86

2.93

2.94

2.9

2.82

2.7

2.56

2.4

2.23

2.05

1.86

1.74

1.61

3.01

3.11

3.15

3.13

3.06

2.96

2.83

2.68

2.51

2.34

2.17

2.01

1.88

1.77

3.3

3.35

3.35

3.3

3.21

3.08

2.94

2.77

2.6

2.42

2.26

2.11

1.98

1.89

3.57

3.58

3.54

3.45

3.33

3.18

3.01

2.83

2.65

2.47

2.31

2.17

2.05

1.98

3.84

3.8

3.72

3.59

3.43

3.26

3.07

2.87

2.67

2.49

2.33

2.19

2.09

2.03

4.1

4.01

3.88

3.71

3.52

3.31

3.09

2.88

2.67

2.47

2.31

2.17

2.07

2.03

4.36

4.21

4.02

3.81

3.58

3.33

3.09

2.85

2.62

2.42

2.25

2.12

2.03

2

4.6

4.39

4.15

3.89

3.61

3.33

3.06

2.79

2.55

2.33

2.15

2.02

1.93

1.91

4.84

4.56

4.26

3.95

3.63

3.31

3

2.7

2.44

2.2

2.01

1.87

1.79

1.78

7/22/2019 PFT

42/42

PEF (L/min): Female

Height (cm)Age

140 145 150 155 160 165 170 175 180

10

15

20

25

30

35

40

45

50

55

60

65

70

75

257.4

283.8

303

315

321

321.6

317.4

309

297.6

283.8

268.2

251.4

234

217.2

282.6

307.2

324

334.8

339

339

334.2

325.2

313.8

300

285

268.8

252.6

237

307.2

329.4

343.8

353.4

356.4

355.2

349.2

340.2

328.8

315

300

284.4

293.4

255

331.8

351.6

364.2

370.8

372.6

369.6

363

353.4

341.4

327.6

313.2

298.2

283.8

271.2

355.8

372.6

383.4

388.2

387.6

383.4

375.6

364.8

352.8

338.4

324

310.2

296.4

284.4

379.8

393.6

401.4

403.8

401.4

396

386.4

375

361.8

348

333.6

319.8

306.6

295.8

403.2

413.4

418.8

418.2

414

406.8

396

383.4

369.6

355.2

340.8

327

315

304.8

426

433.2

435

432

425.4

415.8

403.8

390

375

360

345.6

331.8

320.4

311.4

448.2

451.8

450

444.6

435.6

423.6

409.8

394.8

378.6

363

348

334.8

323.4

315.6

Documents

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