Master pulmonary function testing procedures — and prepare for PFT credentialing exams! Ruppel's Manual of Pulmonary Function Testing, 12th Edition provides comprehensive coverage of common pulmonary function tests, testing techniques, and the pathophysiology that may be evaluated by each test. It also includes information on equipment, measurement software, reference values, and quality assurance, so you can develop the testing skills you need to find and assess lung abnormalities and conditions such as asthma, COPD, and emphysema. Written by Carl D. Mottram, a well-known expert in pulmonary function procedures, this bestselling guide helps you get accurate test results every time.
New to this edition
NEW! Indications for Pulmonary Function Testing chapter Includes updates in alignment with the 2019 ATS-ERS Spirometry Standards.
NEW! Spirometry chapter adds updated Information per the new 2019 ATS-ERS Spirometry Technical Standard.
NEW! Diffusing Capacity Tests chapter is aligned with the 2014 ERS-ATS Technical Standard and the 2017 Global Lung Initiative (GLI) DLCO reference set.
NEW! Bronchoprovocation Challenge Testing chapter is updated with the 2017 ERS Methacholine Challenge Technical Standard and 2018 ERS Indirect Bronchial Challenge Testing (e.g., mannitol, exercise, hyperventilation, cold air).
NEW! Specialized Test Regimens chapter includes 2018 ATS Reference Values in Children.
NEW! Pulmonary Function Testing Equipment chapter is updated with new equipment and vendors.
NEW! Quality Systems in the Pulmonary Function Laboratory chapter is updated with the newest version of the Clinical and Laboratory Standards Institutes (CLSI) Quality Management System (QMS01), which is the basis for any laboratory quality program, and a new table of recommended target CVs for Biological control (BioQC).
NEW! Reference Values and Interpretation Strategies chapter adds new GLI (Global Lung Function Initiative) reference sets for Diffusing of the Lung and Lungs Volumes.
Key Features
Entry- and Advanced-Level objectives prepare you for success on the NBRC’s Pulmonary Function Technologist credentialing examinations and follow the content guidelines of the CPFT and RPFT exam matrices from the National Board for Respiratory Care.
How To boxes provide step-by-step guidelines to performing pulmonary function tests, taking the guesswork out of completing accurate and result-producing tests.
Case studies provide problem-solving challenges for real-life patient scenarios, including each case history, PFT testing results, a technologist’s comments, and questions and answers.
PFT Tips highlight and reinforce the most important pulmonary function testing information in every chapter.
Convenient study features include key terms, chapter outlines, learning objectives, chapter summary points, suggested readings, a glossary, and self-assessment questions.
Authoritative, all-in-one resource eliminates the need to search for information in other sources.
Criteria for acceptability and repeatability are included in each test section, as well as interpretive strategies to help you adhere to recognized testing standards.
Author Information
By Carl Mottram, BA, RRT, RPFT, FAARC, Technical Director Pulmonary Function Labs and Rehabilitation Associate Professor of Medicine Mayo Clinic College of Medicine Rochester, Minnesota
Author(s): Carl D. Mottram
Edition: 12
Publisher: Mosby Elsevier
Year: 2022
Language: English
Commentary: TRUE PDF
Tags: Pulmonary Function Testing; Respiratory Therapy; Respiratory Medicine; Lung Diseases
Front Cover
Inside Front cover
Ruppel's Manual of Pulmonary Function Testing
Copyright
List of Contributors
Preface
Distinctive Features
Text Updates
Using This Book
Evolve Ancillaries
Author’s Commentary
Contents
Chapter 1 Indications for Pulmonary Function Testing
Pulmonary function tests
Airway Function Tests
Lung Volume and Ventilation Tests
Diffusing Capacity Tests
Blood Gases and Gas Exchange Tests
Cardiopulmonary Exercise Tests
Metabolic Measurements
Indications for pulmonary function testing
Spirometry
Lung Volumes
Diffusing Capacity
Blood Gases
Exercise Tests
Patterns of impaired pulmonary function
Obstructive Airway Diseases
Chronic Obstructive Pulmonary Disease
Emphysema
Chronic Bronchitis
Bronchiectasis
Management of Chronic Obstructive Pulmonary Disease
Hyperreactive Airway Disease: Asthma
Management of Asthma
Cystic Fibrosis
Management of Cystic Fibrosis
Upper or Large Airway Obstruction
Management of Upper or Large Airway Obstruction
Restrictive Lung Disease
Pulmonary Fibrosis
Pneumoconiosis
Sarcoidosis
Diseases of the Chest Wall and Pleura
Neuromuscular Disorders
Congestive Heart Failure
Lung Transplantation
Preliminaries to patient testing
Testing During a Pandemic
Before Patient Testing
The 12 QSEs
Patient Preparation (Pretest Instructions)
Withholding Medications
Smoking Cessation
Other Patient Preparation Issues
Anthropometric Measurements
Physical Assessment
Pulmonary History
Test performance and sequence
Technologist-Driven Protocols (Operator-Driven Protocols)
Patient Instruction
Summary
Case study
Selected bibliography
General References
Indications for Pulmonary Function Testing
Patterns of Impaired Pulmonary Function
Preliminaries to Patient Testing
Chapter 2 Spirometry
Vital Capacity
Description
Technique
Significance and Pathophysiology
Forced Vital Capacity, Forced Expiratory Volume, and Forced Expiratory Flow
Description
Technique
Acceptability and Repeatability for Spirometry Results
Significance and Pathophysiology
Forced Vital Capacity
Forced Expiratory Volume
Forced Expiratory Volume Ratio
Forced Expiratory Flow 25% to 75%
Flow-Volume Curve
Description
Technique
Significance and Pathophysiology
Flow-Volume Loops in Small Airway Obstruction
Flow-Volume Loops in Large Airway Obstruction
Flow-Volume Loops in Restrictive Disease
Peak Expiratory Flow
Description
Technique
Significance and Pathophysiology
Maximum Voluntary Ventilation
Description
Technique
Significance and Pathophysiology
Bronchodilator Responsiveness Testing
Description
Technique
Significance and Pathophysiology
Summary
Case Studies
Selected Bibliography
General References
Spirometry
Peak Expiratory Flow
Before- and After-Bronchodilator Studies
Flow-Volume Curves
Standards and Guidelines
Chapter 3 Diffusing Capacity Tests
Carbon monoxide diffusing capacity
Description
Techniques
Single Breath-Hold Technique (Modified Krogh’s Technique)
Hemoglobin Correction/Adjustment
Carboxyhemoglobin Correction/Adjustment
Altitude Correction/Adjustment
Rebreathing Technique
Slow Exhalation Single-Breath Intrabreath Method
Membrane Diffusion Coefficient and Capillary Blood Volume
Significance and Pathophysiology
Summary
Case studies
Selected bibliography
General References
Dlcosb
Dlcorb
Dlcoib
Standards and Guidelines
Chapter 4 Lung Volumes, Airway Resistance, and Gas Distribution Tests
Lung Volumes: Functional Residual Capacity, Residual Volume, Total Lung Capacity, And Residual Volume/Total Lung Capacity R ...
Description
Technique
Open-Circuit, Multiple-Breath Nitrogen Washout
Closed-Circuit, Multiple-Breath Helium Dilution
Correcting for the “Switch-In” Error
Additional Comments on FRC by Gas-Dilution Techniques
Body Plethysmography
Additional Comments on FRC by Plethysmography
Total Lung Capacity and Residual Volume/Total Lung Capacity Ratio
Significance and Pathophysiology
Airway Resistance and Conductance
Description
Technique
Significance and Pathophysiology
Gas Distribution Tests: Single-Breath Nitrogen Washout, Closing Volume, and Closing Capacity
Description
Technique
Significance and Pathophysiology
Δ %N 2 750–1250
Slope of Phase III
Closing Volume and Closing Capacity
Multiple-Breath Nitrogen Washout, Lung Clearance Index, And Phase III Slope Analysis
Description
Technique
Significance and Pathophysiology
Summary
Case Studies
Selected Bibliography
General References
Spirometry and Lung Volumes
Plethysmographic Lung Volumes
Airway Resistance
Gas Dilution Lung Volumes
Gas Distribution
Standards and Guidelines
Chapter 5 Ventilation and Ventilatory Control Tests
Tidal volume, rate, and minute ventilation
Description
Technique
Significance and Pathophysiology
Respiratory dead space and alveolar ventilation
Description
Technique
Dead Space
Alveolar Ventilation
Significance and Pathophysiology
Ventilatory response tests for carbon dioxide and oxygen
Description
Technique
Ventilatory Response to CO 2
Ventilatory Response to O 2
Significance and Pathophysiology
High-altitude simulation test
Description
Technique
Significance and Pathophysiology
Summary
Case studies
Selected Bibliography
General References
Ventilation
Control of Ventilation
High-Altitude Simulation Test (or Hypoxic Inhalation Test)
Chapter 6 Blood Gases and Related Tests
PH
Carbon dioxide tension
Oxygen tension
Techniques
pH
Carbon Dioxide Tension
Oxygen Tension
Specimen Collection for Blood Gases
Significance and Pathophysiology
pH
Carbon Dioxide Tension
Oxygen Tension
Hemoximetry
Description
Technique
Significance and Pathophysiology
Pulse oximetry
Description
Technique
Significance and Pathophysiology
Capnography
Description
Technique
Significance and Pathophysiology
Shunt calculation
Description
Technique
Significance and Pathophysiology
Summary
Case studies
Selected bibliography
General References
Blood Gases
Pulse Oximetry
Capnography
Shunt Calculation
Standards and Guidelines
Chapter 7 Cardiopulmonary Exercise Testing and Field Tests
Field tests
Six-Minute Walk Test
Six-Minute Walk Test Reference Set
Shuttle Walk Tests
Exercise protocols and reference sets
Reference Sets
Exercise workload
Cardiovascular monitors during exercise
Heart Rate and Electrocardiogram
Blood Pressure
Safety
Ventilation during exercise
Equipment Selection and Calibration
Fraction of Mixed Expired CO 2 (F eco 2)
Minute Ventilation
Tidal Volume and Respiratory Rate
Flow-Volume Loop Analysis
Oxygen consumption, carbon dioxide production, and respiratory exchange ratio during exercise
Oxygen Consumption
Carbon Dioxide Production
Respiratory Exchange Ratio
Anaerobic or Ventilatory Threshold
Ventilatory Equivalent for Oxygen
Ventilatory Equivalent for Carbon Dioxide
Oxygen Pulse
Exercise blood gases
Arterial Catheterization
Arterial Puncture
Pulse Oximetry
Arterial Oxygen Tension During Exercise
Arterial Carbon Dioxide Tension During Exercise
Acid–Base Status During Exercise
Exercise Variables Calculated from Blood Gases
Cardiac output during exercise
Noninvasive Cardiac Output Techniques
Direct Fick Method
Thermodilution Method
Cardiac Output During Exercise
Symptom Scales
Quality of Test
Interpretation Strategies
Summary
Case studies
Selected bibliography
General References
Six-Minute Walk Test
Reference Equations
Cardiovascular Monitoring During Exercise
Ventilation, Gas Exchange, and Blood Gases
Standards and Guidelines
Chapter 8 Pediatric Pulmonary Function Testing
Infant, toddler, and preschool pulmonary function testing
Purpose of Pulmonary Function Tests for Infants and Toddlers
Performance of Pulmonary Function Testing in Infants and Toddlers
Sedation as an Important Consideration
When Children Are Too Old for Infant-Style Testing and Too Young for Standard Testing
Lung Volume Measurement
Multiple-Breath Washout Including Lung Clearance Index
Passive Tidal Techniques to Measure Respiratory Mechanics
Passive Tidal Loops
Passive Compliance, Resistance, and Time Constants
Thoracoabdominal Motion Analysis
Additional Passive Techniques Available to Measure in the Preschool Child
Impulse Oscillometry
Interrupter Technique
Forced Flow Techniques for Infants, Toddlers, and Preschool Children
Partial Expiratory Flow-Volume Curves
Forced Flows From Raised Lung Volume
Forced Deflation Technique
Spirometry
Age Considerations for Children Performing Spirometry
Ensuring Maximal Effort on the Part of the Child
Importance of Effort
Length of Exhalation for a Child During an FVC Maneuver
Reliability of FEF 25%–75% in Children
Maximal Voluntary Ventilation
Parameters of the Inspiratory Flow-Volume Loop
Role of Vocal Cord Dysfunction
VCD Combined With Airflow Obstruction
FVC-Induced Bronchospasm
Airway Malacia
Diffusion capacity
Respiratory muscle strength
Maximal Respiratory Pressures
Cough Peak Flows
Sniff Nasal Inspiratory Pressures
Lung volumes
First Step
Important Plethysmographic Parameters
Role of Measurement of Airway Resistance
Bronchoprovocation challenges
Pulmonary exercise stress testing
Exhaled nitric oxide and nasal nitric oxide
Reference sets and predicted values for pediatrics
Arterial blood gases
Summary
Case studies
Selected Bibliography
Spirometry
Predicted Values and Reference Equations
Vocal Cord Dysfunction and Obstructing Upper Airway Lesions
Respiratory Muscle Strength
Exercise Stress Testing
Pulmonary Function Testing in Infants and Very Young Children
Oscillometry and Nitric Oxide
Standards and Guidelines
General References
Chapter 9 Bronchoprovocation Challenge Testing
Bronchoprovocation challenge testing
Methacholine Challenge
Five-Breath Dosimeter Method
1-Minute Tidal Breathing Method
Histamine Challenge
Mannitol Challenge
Exercise Challenge
Eucapnic Voluntary Hyperventilation
Summary
Case studies
Selected bibliography
Bronchial Challenge
Guidelines and Standards
Chapter 10 Specialized Tests and Evaluations
Respiratory muscle strength testing
Maximal Respiratory Pressures
Description
Technique
Significance and Pathophysiology
Cough Peak Flow
Description
Technique
Significance and Pathophysiology
Sniff Nasal Inspiratory Pressures
Description
Technique
Significance and Pathophysiology
Exhaled nitric oxide
Description
Techniques
Online F e NO
Offline F e NO
Nasal Nitric Oxide
Significance and Pathophysiology
Forced oscillation technique
Preoperative pulmonary function testing
Spirometry
Bronchodilator Studies
Blood Gas Analysis
Exercise Testing
Diffusing Capacity (D lco)
Perfusion and Scans
Pulmonary function testing for social security disability
Forced Vital Capacity and Forced Expiratory Volume
Diffusing Capacity
Arterial Blood Gases
Pulse Oximetry
Exercise Testing
Metabolic measurements: indirect calorimetry
Description
Techniques
Open-Circuit Calorimetry
Closed-Circuit Calorimetry
Performing Metabolic Measurements
Metabolic Calculations
Significance and Pathophysiology
Summary
Case studies
Selected bibliography
Respiratory Muscle Strength Testing
Exhaled Nitric Oxide
Forced Oscillation Technique
Preoperative Pulmonary Function Testing
Respiratory Impairment for Disability
Metabolic Measurements: Indirect Calorimetry
Guidelines and Standards
Chapter 11 Pulmonary Function Testing Equipment
Volume-displacement spirometers
Dry-Seal Spirometers
Dry Rolling Seal Spirometers
Bellows-Type Spirometers
Flow-sensing spirometers
Turbines
Pressure-Differential Flow Sensors
Heated-Wire Flow Sensors
Pitot Tube Flow Sensors
Ultrasonic Flow Sensors
Flow Sensor Summary
Portable (Office or Home) Spirometers
Peak flowmeters
Body plethysmographs
Pressure Plethysmographs
Flow Plethysmographs
Breathing valves
Free Breathing and Demand Valves
Directional Valves
Gas-Sampling Valves
Pulmonary gas analyzers
Oxygen Analyzers
Polarographic Electrodes
Zirconium Fuel Cells
Infrared Absorption (CO 2, CO) Analyzers
Emission Spectroscopy Analyzers
Thermal Conductivity Analyzers
Gas Chromatography
Chemiluminescence Analyzers
Gas-Conditioning Devices
Blood gas analyzers, oximeters, and related devices
pH Electrodes
P co 2 Electrodes
P o 2 Electrodes
Laboratory Analyzers
Point-of-Care Analyzers
Transcutaneous P o 2 and P co 2 Electrodes
Spectrophotometric Oximeters
Pulse Oximeters
Reflective Spectrophotometers
Computers for pulmonary function testing
Data Acquisition and Instrument Control
Pulmonary Function Data Storage and Programs
Permanent Individual Patient Data Files
Database Storage
Summary
Self-Assessment Questions
Selected bibliography
Spirometers
Peak Flowmeters
Plethysmographs
Gas Analyzers
Blood Gas Electrodes, Oximeters, and Related Devices
Computers
Chapter 12 Quality Systems in the Pulmonary Function Laboratory
Quality manual
Quality system essentials
Organization and Leadership
Customer Focus
Facilities and Safety
Pulmonary Function Tests
Blood Gases
Personnel
Supplier and Inventory Management
Equipment
Installation, Validation, and Verification
Equipment Maintenance
Process Management
Control Methods: Mechanical and Biologic
Quality Control Tools and Materials
Syringes
Sine-Wave Rotary Pumps
Computerized Syringes
Computer-Driven Syringes
Explosive Decompression Devices
D lco Simulator
Quality Control Concepts
Spirometry Calibration and Mechanical Quality Control
Gas Analyzers and D lco Systems
Physiologic Range
Sampling Conditions
Two-Point Calibration
Multiple-Point (Linearity) Calibration
D lco Systems
Body Plethysmographs
Mouth Pressure Transducer
Box Pressure Transducer
Flow Transducer
Biologic Controls
Calibration and Quality Control of Blood Gas Analyzers
Commercially Prepared Controls
Documents and Records
Information Management
Nonconforming Event Management
Assessments
Continual Improvement
Technologist’s Feedback
Path of workflow
Pretest Process
Testing
Test Method Selection
Test Performance
Using Criteria for Acceptability/Repeatability
Examine Printed Tracings or Displayed Graphics Whenever Available
Look at Numeric Data
Evaluate Key Indicators
After Testing
Summary
Case studies
Selected bibliography
General References
Standards and Guidelines
Calibration and Quality Control
Chapter 13 Reference Values and Interpretation Strategies
Selecting and using reference values
Spirometry
Lung Volumes
Diffusing Capacity
Establishing what is abnormal
Pulmonary function testing interpretation—“bringing it all together”
Interpretation algorithm
Quality Review and “The Graph”
The Ratio”
Gas Exchange
Bronchodilator Response (BDR)
Grading Severity and Assessing Change in Lung Function
Summary
Case studies
Selected bibliography
General
Spirometry
Lung Volumes
Diffusing Capacity
Appendix A Answers to Self-Assessment Questions
Chapter 1, Indications for Pulmonary Function Testing
Chapter 2, Spirometry
Chapter 3, Diffusing Capacity Tests
Chapter 4, Lung Volumes, Airway Resistance, and Gas Distribution Tests
Chapter 5, Ventilation and Ventilatory Control Tests
Chapter 6, Blood Gases and Related Tests
Chapter 7, Cardiopulmonary Exercise Testing and Field Tests
Chapter 8, Pediatric Pulmonary Function Testing
Chapter 9, Bronchoprovocation Challenge Testing
Chapter 10, Specialized Tests and Evaluations
Chapter 11, Pulmonary Function Testing Equipment
Chapter 12, Quality Systems in the Pulmonary Function Laboratory
Chapter 13, Reference Values and Interpretation Strategies
Index
Inside Back Cover
