Unit 1 - PFT Purpose + Process

Question 1

What is an example of a pulmonary function test involving arterial blood?

Answer 1

Blood gas analysis (ABG)
- used to measure the levels of oxygen and carbon dioxide in the blood.

Question 2

What invasive procedure can also be considered a pulmonary function test?

Answer 2

Bronchoscopy
- allows direct visualization of the airways and can aid in diagnostics.

Question 3

What can chest X-rays indicate about lung function?

Answer 3

• Air trapping
• interstitial lung disease
• hyperinflation and other abnormalities

Note: Chest X-rays are a common imaging technique used to assess lung conditions.

Question 4

What does a cardiac stress test assess in relation to pulmonary function?

Answer 4

Whether enough oxygen is reaching the heart
- help evaluate heart function under stress and its relationship to pulmonary health.

Question 5

What is the body box (plethysmograph) used for in PFT?

Answer 5

Measuring lung flows and volumes

The body box provides detailed information about lung function and air distribution.

Question 6

Conventionally, what does pulmonary function testing (PFT) refer to?

Answer 6

A select few diagnostic tests designed to assess specific pulmonary parameters (flows, volumes, and O₂ exchange)

PFT is essential for diagnosing various respiratory conditions.

Question 7

What are the general features of conventional PFT tests?

Answer 7

They are voluntary, require patient coordination and cooperation, and use specialty equipment

Effective testing relies heavily on patient engagement.

Question 8

What are three examples of PFT equipment?

Answer 8

• Body box (plethysmograph)
• Microlab/Microloop devices
• Smaller handheld spirometry devices connected to computers

These devices vary in complexity and application.

Question 9

What is the intent of PFT equipment such as body boxes and handheld devices?

Answer 9

To measure flows and volumes required for testing according to ATS criteria

ATS stands for the American Thoracic Society, which sets guidelines for pulmonary function testing.

Question 10

What are four general categories of pulmonary function tests?

Answer 10

• Lung volumes (e.g., spirometry, plethysmography)
• Pulmonary mechanics (e.g., resistance, respiratory muscle strength)
• Gas distributions (e.g., blood gases, diffusion)
• Stress/exercise (e.g., metabolic testing, exercise-induced asthma)

Each category assesses different aspects of lung function.

Question 11

What are the three most common PFT tests?

Answer 11

• Spirometry (e.g., FVC, flow volume loop)
• Lung volume testing (e.g., plethysmography)
• Diffusion capacity testing (e.g., DLCO)

These tests are foundational in evaluating respiratory health.

Question 12

What does spirometry test for?

Answer 12

Lung volume and speed of airflow.

Question 13

What instruction is typically given to patients during spirometry?

Answer 13

“Biggest breath in and fastest breath out.”

Question 14

What values can spirometry provide?

Answer 14

• Forced Expiratory Volume (FEV₁, FEV₆)
• Forced Vital Capacity (FVC)
• Peak Expiratory Flow (PEF).

Question 15

What does FVC represent?

Answer 15

The fastest vital capacity a patient can deliver.

Question 16

What does PEF represent?

Answer 16

The strongest maneuver that generates maximum flow.

Question 17

On a flow-volume loop graph, where are expiratory and inspiratory values plotted?

Answer 17

Expiratory values are above the baseline (positive)
- inspiratory values are below the baseline (negative).

Question 18

What does the graph on the right side of spirometry examples represent?

Answer 18

A time-volume loop.

Question 19

What does plethysmography test for?

Answer 19

Total lung size and all lung divisions.

Question 20

What values can plethysmography provide?

Answer 20

• Total Lung Capacity (TLC)
• Functional Residual Capacity (FRC)
• Residual Volume (RV)
• Airway Resistance (Raw).

Question 21

What is the difference between lung volumes and lung capacities in plethysmography?

Answer 21

• Volumes are single values
• capacities are combinations of volumes.

Question 22

Define the following: VT, IRV, ERV, RV.

Answer 22

• VT = Tidal volume (resting breathing)
• IRV = Inspiratory Reserve Volume (max you can inhale above VT)
• ERV = Expiratory Reserve Volume (max you can exhale past VT)
• RV = Air remaining after maximum exhalation (cannot be removed).

Question 23

What does DLCO measure?

Answer 23

Diffusion capacity — how effectively gas transfers across the alveolar-capillary membrane.

Question 24

What gases are typically used in DLCO testing?

Answer 24

Carbon monoxide (CO) and methane (trace gas).

Question 25

What is the common sequence for a full pulmonary function (PF) test?

Answer 25

- Spirometry (pre-bronchodilator) - Lung volumes, Bronchodilator administration - Diffusion capacity testing - Spirometry (post-bronchodilator).

Question 26

Why is the order of PFT steps important?

Answer 26

Earlier values contribute to interpreting later results.

Question 27

What is the standard bronchodilator dose used during PF testing?

Answer 27

Usually 4 puffs of Ventolin.

Question 28

Why is post-bronchodilator spirometry important?

Answer 28

It indicates the degree of change and can help differentiate between asthma and COPD.

Question 29

What are some indications for PF testing?

Answer 29

- Diagnose, localize, or rule out pulmonary diseases, - Investigate respiratory symptoms (chronic cough, wheezing, chest discomfort) - Determine severity or progression of disease.

Question 30

What other purposes does PF testing serve?

Answer 30

- Evaluate lung function due to therapies/treatments - Assess risks (e.g., workplace/environmental, surgical readiness) - Research involving cardiopulmonary function.

Question 31

Where does PF testing occur?

Answer 31

Everywhere RTs work: PF labs, ER departments, hospital wards, community/home care, and ICUs.

Question 32

What is shown on the left image of PF testing equipment?

Answer 32

A microlab/microloop device.

Question 33

Where can PF testing be performed outside formal labs?

Answer 33

In emergencies, or anywhere a patient can sit down and perform the test.

Question 34

Can a ventilator (e.g., PB 840) perform some PF measures?

Answer 34

Yes, it can test some lung functions.

Question 35

Can PF testing occur at home?

Answer 35

Yes — through telemedicine or home-based devices.

Question 36

How may the goals of PF testing differ for a patient in the ER with an asthma exacerbation?

Answer 36

The goal may be rapid assessment and immediate management of airflow limitation.

Question 37

How may the goals differ for a patient in a PF lab with possible asthma but no symptoms?

Answer 37

The goal is accurate diagnosis and baseline measurement.

Question 38

How may the goals differ for a patient with muscular dystrophy admitted with pneumonia?

Answer 38

The goal is to assess respiratory muscle strength and evaluate the impact of infection.

Question 39

How can the setting influence PFTs? (Part 1)

Answer 39

Types of tests differ (ER may only do spirometry, while labs do full PFTs) and goals differ (trend monitoring vs precise values).

Question 40

How can the setting influence PFTs? (Part 2)

Answer 40

Strictness of ATS criteria differs (labs more standardized than ER/ward) and tester experience and ability to coach effort may differ.

Question 41

What does a full PFT report include?

Answer 41

Measured values, predicted values, and percent change.

Question 42

Who interprets PFT reports?

Answer 42

Physicians or nurse practitioners (not RTs).

Question 43

Before starting any PF test, what three things should be confirmed?

Answer 43

* Is it safe for the patient? * Is this the right time for the patient? * Is the device functioning and reliable?

Question 44

What are potential risks of forceful PFT efforts?

Answer 44

High intrathoracic pressures affecting other body systems.

Question 45

Which body systems may be affected by forceful efforts in PFT?

Answer 45

* Cerebral * Ocular * Cardiovascular * Abdominal * Pulmonary

Question 46

What are some cardiovascular and surgical contraindications to PFT?

Answer 46

- Recent myocardial infarction (past week or longer) - Aortic aneurysm - Pulmonary embolism - Active angina - Recent abdominal or cerebral surgery (past week/month)

Question 47

What are other medical contraindications to PFT?

Answer 47

- Unknown hemoptysis - Communicable respiratory disease (e.g., TB, COVID-19) - Confusion or dementia - Significant hypo- or hypertension

Question 48

How do labs help assess risk before testing?

Answer 48

By having patients complete a pre-test questionnaire.

Question 49

What are clinical indications to stop PF testing?

Answer 49

- Onset of chest pain/angina - Lightheadedness or dizziness that does not resolve post-maneuver - Confusion - Nausea - Ataxia - Pallor - Hemoptysis

Question 50

What are patient- or test-related indications to stop PF testing?

Answer 50

1. Progressive worsening of spirometry data or signs of bronchospasm 2. Termination of test due to fatigue or shortness of breath 3. Patient request to stop or refusal to continue testing

Question 51

Is doing a PFT physically demanding, and is it generally safe?

Answer 51

Yes, it requires maximum effort multiple times, but PFTs are generally safe.

Question 52

What is the most common symptom during PFT?

Answer 52

Syncope (fainting or passing out).

Question 53

Which patients are at greatest risk for fainting or complications during PFT?

Answer 53

Patients with hypotension, respiratory impairment, or other comorbid conditions.

Question 54

How may the relative risk of PF testing differ in patients with different conditions?

Answer 54

Laparoscopic (“keyhole”) surgery has lower risk than abdominal wall incision. Active TB has higher risk than latent TB. Chest pain from chronic cough poses lower risk than chest pain from exertion (e.g., walking to lab).

Question 55

What patient activities or factors should be avoided before PF testing because they affect results?

Answer 55

- Exercise - Smoking - Drinking alcohol - Tight clothing on chest/abdomen - Large meals - Respiratory medications

Question 56

Why should patients withhold certain respiratory medications before PF testing?

Answer 56

Because bronchodilators can alter baseline measurements and prevent accurate assessment of reversibility.

Question 57

What type of medication is Ventolin (salbutamol), and why must it be withheld before testing?

Answer 57

A short-acting beta agonist (SABA). - If taken, it interferes with post-bronchodilator testing and makes it harder to distinguish between asthma and COPD.

Question 58

What type of medication is Spiriva, and how might it affect PF testing if taken before?

Answer 58

A long-acting muscarinic antagonist (LAMA). - It affects bronchodilation state and may lower airway resistance if inflammation has improved.

Question 59

What are key patient preparation instructions before testing? (Things to DO)

Answer 59

1. Arrive 15 minutes early 2. Wear comfortable clothing 3. Bring BC Services Card or photo ID 4. Bring list of breathing medications 5. Continue non-respiratory medications as prescribed.

Question 60

What are key patient preparation instructions before testing? (Things to AVOID)

Answer 60

- Perfume/aftershave - Physical exercise right before test - Smoking within 1 hr - Large meal within 2 hrs - Alcohol within 4 hrs - Inhalers (unless symptoms acute) - Caffeine before methacholine challenge.

Question 61

What are the withholding times for bronchodilators before PF testing?

Answer 61

- SABA (albuterol/salbutamol): 4–6 hrs - SAMA (ipratropium): 12 hrs - LABA (formoterol/salmeterol): 24 hrs - Ultra-LABA (indacaterol/vilanterol/olodaterol): 36 hrs - LAMA (tiotropium/umeclidinium/aclidinium/glycopyrronium): 36–48 hrs.

Question 62

Why is it critical for PF devices to be reliable?

Answer 62

Inaccurate devices can lead to false interpretation of patient results.

Question 63

How often should PF devices be calibrated?

Answer 63

Daily, against a known value, as part of quality assurance.

Question 64

Who sets criteria for acceptable PF tests in North America?

Answer 64

The American Thoracic Society (ATS).

Question 65

Why is knowing ATS criteria important for RTs?

Answer 65

Helps them determine in the moment whether a test is acceptable, even though expertise in criteria alone doesn’t make someone an expert tester.

Question 66

Why is RT coaching ability critical during PF testing?

Answer 66

Coaching ensures maximum patient effort, improving test quality. ## Footnote Patients don’t need to be awake for blood glucose, ABG, total hemoglobin, or plateau pressure. Like running with a coach, patients perform better with RT guidance.

Question 67

What is the most valuable thing an RT brings to PF testing?

Answer 67

Consistency, adaptability, and coaching — recognizing how to optimize the patient’s effort (e.g., posture, encouragement) to get the best result.

Question 68

Why is patient effort critical in PFTs?

Answer 68

PFTs are unique because patient effort directly affects results (e.g., spirometry requires the patient to be awake and able to perform).

Question 69

Can PFTs be done if the RT doesn’t speak the same language as the patient?

Answer 69

With translator/family help, yes.

Question 70

Can PFTs be done if the patient cannot hear instructions?

Answer 70

Possibly, but very difficult.

Question 71

Can PFTs be done if the patient is unmotivated?

Answer 71

Sometimes, but not always successful.

Question 72

Can PFTs be done if the patient cannot follow commands?

Answer 72

No — PFT cannot be attempted without coordination.

Question 73

What does effective coaching during PFT require?

Answer 73

Knowing equipment and test steps, understanding why steps are needed, motivating without aggravating, observing the patient during the test, giving feedback, knowing when to stop testing.

Question 74

Why must RTs also relate well to patients during coaching?

Answer 74

Even the best advice won’t work if delivered poorly; communication style is key.

Question 75

Why is coaching ability so important in PF testing?

Answer 75

Better coaching → better patient effort → better test results → more accurate diagnosis. Poor effort could mimic restrictive/obstructive disease falsely.

Question 76

How can PFT results impact patients’ lives? (Examples)

Answer 76

13-year-old diagnosed with asthma → treatment, lifestyle change - Patient with chronic SOB/cough diagnosed with pulmonary fibrosis → prognosis and treatment decisions - Miner with decreasing lung function → may require new job duties or career change - Patient with exercise-induced asthma → lifestyle limitation, emotional impact.