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Other Spirometry Patterns – Laboratory Diagnostics

by Carlo Raj, MD
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    00:00 Are you seeing this? Let's continue.

    00:00 Other important patterns that you want to keep in mind. You will like this. Watch. The first one is called fixed obstruction. What does this mean? Well, this could mean that first and foremost, let’s begin the same way, organisation.

    00:18 The loop spirometry, different pathologic patterns that you are responsible for understanding.

    00:21 We will begin with residual volume. Okay. Does this-Does this even look normal? No, it doesn’t. Actually, the both, the bottom half and the top half look like they are kind of sandwiched, isn’t it? It looks like a-a burger, doesn’t it? Looks like buns. That’s what it looks like. And that black line in the middle, that is your piece of bacon. I don’t know, whatever. So, the point is they are compressed. What happened here? There is difficulty with inspiration, hence flattened and there is also difficulty with expiration. What the heck kind of disease is going to give you a fixed obstruction? A ENT tumour. In other words, you have perhaps dangerous, a head and neck type of cancer. When there is a head and neck type of tumour, cancer, this is then causing a fixed large obstruction of both inspiration which is the bottom half of the curve and the top half.

    01:16 That is fixed. Let's move on to another one.

    01:20 Now, first and foremost, dissect the curve, interpret this. Where is my problem, please? Inspiration? Exhalation? Good. Inspiration only. You see that there is only a problem with inspiration. Wow! What the heck kind of problem or disease of pathology has given me a problem with inspiration only? The problem is extra thoracic pathology. Meaning, maybe with the vocal cords. So, with the vocal cord type of dysfunction or maybe perhaps fibrosis or an upper airway mass, this is the most tested, well, please understand, that you are going to have a hard time inspiring. Is that clear? So, therefore, the bottom half of the curve has not been affected. But, you do not have problems at getting the air out.

    02:09 This is not, I repeat, anything to do with obstructive in terms of the pulmonary issue. Obstructive here, I wouldn’t even use this word. I would just think of this as being inspiratory issues.

    02:22 Now, we do think about obstructive. I want you to keep the theme of obstructive and inside the lung. First and foremost, interpret the curve for me. Where is my problem? Good. The top half. What does that top half represent? Exhalation. Interesting! Earlier discussion, I just showed you obstructive lung disease with scalloped type of second half of exhalation with a left shift, meaning to say, an increase in TLC. That was obstructive. Here, please understand, when you have such a obstructive pattern, that you will see at some point in time, that this is a problem inside my lung and this will be something like obstructive disease, or but also, intrathoracic tumour whereas the tumour in the first one, fixed.

    03:15 Where was it? Oh, ENT. Ear, Nose, Throat. Clear? Blocking, fixed. What was the one with extrathoracic? That was vocal cord, problem with inspiration only. More common than you think, especially in health care workers. Vocal cords often times, often times damaged.

    03:34 Now, under the three main categories, take a look at lung volumes. TLC, residual volume, and once again, the Gold standard here for measuring lung volume will be a body box, plethysmography. Lung volumes used in measuring residual volume, we talked about that spirometry cannot, report’s out, your TLC and vital capacity will be two big ones. Then reduced TLC seen in what kind of disease, please? Good. Restrictive. Elevated TLC and residual volume will be seen in what kind of disease, please? Good. Obstructive. We will call this hyperinflation.


    About the Lecture

    The lecture Other Spirometry Patterns – Laboratory Diagnostics by Carlo Raj, MD is from the course Pulmonary Diagnostics.


    Included Quiz Questions

    1. Fixed obstruction.
    2. Variable intrathoracic.
    3. Variable extrathoracic.
    4. Obstructive.
    5. Restrictive.
    1. Variable extrathoracic
    2. Variable intrathoracic
    3. Obstructive
    4. Fixed obstructive
    5. Restrictive
    1. It represents an exhalation dysfunction.
    2. It represents an inhalation dysfunction.
    3. It shows a decrease in residual volume.
    4. It shows a decrease in TLC.
    5. It represents a mixed obstructive and restrictive pattern.

    Author of lecture Other Spirometry Patterns – Laboratory Diagnostics

     Carlo Raj, MD

    Carlo Raj, MD


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