Emphysema pulmonary function tests

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

At age 12, the patient was admitted with acute chest pain from a left spontaneous pneumothorax (air within the pleural cavity).This required hospitalization and chest tube insertion, but he recovered without sequelae. After the resolution of this problem, pulmonary function testing revealed findings of both severe airway obstruction and destruction of alveolar lung tissue, consistent with emphysema. No further pulmonary problems occurred until the patient was age 16 years, when he developed occasional episodes of bronchospasm (spasmodic contraction of the smooth muscles of the bronchus). Pulmonary function studies at that time, though improved from those immediately following his pneumothorax, still revealed combined obstructive and destructive lung disease. 

Zaporozhan J, Ley S, Eberhardt R et al. (2005) Paired inspira-tory/expiratory volumetric thin-slice CT scan for emphysema analysis comparison of different qimntitative evaluations and pulmonary function test. Chest 128 3212-3220 Zaporozhan J, Ley S, Weinheimer O etal. (2006) Multi-detector CT of the chest influence of dose onto quantitative evaluation of severe emphysema a simulation study. J Comput Assist Tomogr 30 460-468 Zhang J, Hasegawa I, Feller-Kopman D, Boiselle PM (2003) 2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways comparison of standard-dose and low-dose techniques. Acad Radiol 10 719-724... 

Gurney JW, Jones KK, Robbins RA, Gossman GL, Nelson KJ, Daughton D, Spurzem JR, Rennard SI (1992) Regional distribution of emphysema correlation of high-resolution CT with pulmonary function tests in unselected smokers. Radiology 183 457-463... 

Kinsella M, Muller N, Vedal S, Staples C, Abboud RT, Chan-Yeung M (1990) Emphysema in silicosis. A comparison of smokers with nonsmokers using pulmonary function testing and computed tomography. Am Rev Respir Dis 141 1497-1500... 

In one study of long-term outcome of 33 nonsmoking FL dating back at least 6 years (Lalan-CETTE et al. 1993), pulmonary function tests revealed an obstructive profile in 13 subjects, restrictive changes in 1, an isolated decrease in lung diffusion capacity in 3, and normal values in 16. Thin-section CT revealed emphysema in 9 of the patients who had airflow obstruction. 

As with other obstructive pulmonary diseases (e.g., asthma), spirometric tests will indicate a decrease in FEVj and an increase in the total forced expiratory time (the total time required to exhale the entire vital capacity of the lung). In emphysema, all of these pulmonary function parameters are altered due to a loss of the elastic recoil properties of the lung and a collapse of the intrathoracic airways during forced expiration, both of these phenomena being caused by the destruction of the interstitial connective tissue. 

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