The function of upper breathing as carried out. Comparative characteristics of the parameters of the function of external respiration (literature review)

Inhalation and exhalation for a person is not just a physiological process. Remember how we breathe in different life circumstances.

Fear, anger, pain - breath is clamped and constrained. Happiness - for the manifestation of joy there are not enough emotions - we breathe deeply.

Another example with the question: how long will a person live without food, sleep, water? And without air? Probably, we should not continue talking about the importance of breathing in human life.

Breathing at a Glance

The ancient Indian teaching of yoga states: “A person’s life is the time periods between inhalation and exhalation, because these movements, which saturate all cells with air, ensure his very existence.”

A person who breathes half, also lives half. This, of course, is about unhealthy or improper breathing.

How can you breathe incorrectly, the reader will object, if everything happens without the participation of consciousness, so to speak "on the machine." The smart guy will continue - unconditioned reflexes control breathing.

The truth lies in the psychological trauma and all sorts of diseases that we accumulate throughout our lives. It is they who make the muscles clamped (overstrained) or, conversely, lazy. Therefore, over time, the optimal mode of the respiratory cycle is lost.

It seems to us that the ancient man did not think about the correctness of this process, nature itself did it for him.

The process of filling human organs with oxygen is divided into three components:

1. Clavicular (upper). Inhalation occurs due to the upper intercostal muscles and clavicles. Try it to make sure that this mechanical movement does not fully rotate the chest. Little oxygen enters, breathing becomes frequent, incomplete, dizziness occurs and the person begins to suffocate.
2. Medium or breast. With this type, the intercostal muscles and the ribs themselves are included. The chest expands as much as possible, allowing it to be completely filled with air. This type is typical under stressful circumstances or with mental stress. Remember the situation: you are excited, but if you take a deep breath, everything disappears somewhere. This is the result of proper breathing.
3. Abdominal diaphragmatic breathing. This type of breathing, from the point of view of anatomy, is the most optimal, but, of course, not quite comfortable and familiar. You can always use it when you need to relieve mental "strained". Relax the abdominal muscles, lower the diaphragm to a lower position, then return it back to its original position. Pay attention, there was a calm in the head, thoughts brightened up.

Important! By moving the diaphragm, you not only improve your breathing, but also massage the abdominal organs, improving metabolic processes and digestion of food. Due to the movement of the diaphragm, the blood supply to the digestive organs and venous outflow are activated.

This is how important it is for a person not only to breathe correctly, but also to have healthy organs that ensure this process. Constant monitoring of the condition of the larynx, trachea, bronchi, and lungs largely contributes to the solution of these problems.

Examination of the function of external respiration

FVD in medicine, what is it? To test the functions of external respiration, a whole arsenal of techniques and procedures is used, the main task of which is to objectively assess the condition of the lungs and bronchi, as well as to open the pathology at an early stage.

The gas exchange process that occurs in the tissues of the lungs, between blood and air from outside, penetrating the body, medicine calls external respiration.

Research methods that allow diagnosing various pathologies include:

1. Spirography.
2. Bodyplethysmography.
3. Study of the gas composition of exhaled air.

Important! The first four methods of analysis of respiratory function allow you to study in detail the forced, vital, minute, residual and total volume of the lungs, as well as the maximum and peak expiratory flow. While the gas composition of the air leaving the lungs is studied using a special medical gas analyzer.

In this regard, the reader may have a false impression that the examination of the respiratory function and spirometry are one and the same. We emphasize once again that the study of respiratory function is a whole range of tests, which includes spirometry.

Indications and contraindications

There are indications for complex testing of the functions of upper breathing.

These include:

1. Patients, including children, who manifest: bronchitis, pneumonia, emphysema of lung tissue, nonspecific lung diseases, tracheitis, rhinitis in various forms, laryngotracheitis, diaphragmatic damage.
2. Diagnosis and control and COPD (chronic obstructive pulmonary disease).
3. Examination of patients involved in hazardous areas of production (dust, varnishes, paints, fertilizers, mines, radiation).
4. Chronic cough, shortness of breath.
5. The study of upper breathing in preparation for surgical operations and invasive (taking living tissue) examinations of the lungs.
6. Examination of chronic smokers and people prone to allergies.
7. Professional athletes, in order to find out the maximum capacity of the lungs during increased physical exertion.

At the same time, there are restrictions that make it impossible to conduct a survey due to certain circumstances:

1. Aneurysm (protrusion of the wall) of the aorta.
2. Bleeding in the lungs or bronchi.
3. Tuberculosis in any form.
4. Pneumothorax is when a large amount of air or gas accumulates in the pleural region.
5. Not earlier than one month after undergoing surgery on the abdominal or thoracic cavity.
6. After a stroke and myocardial infarction, the study is possible only after 3 months.
7. Intellectual retardation or mental disorders.

Video from an expert:

How is the research done?

Despite the fact that the procedure for studying the respiratory function is a completely painless process, in order to obtain the most objective data, it is necessary to carefully approach its preparation.

1. FVD is done on an empty stomach and always in the morning.
2. Smokers should abstain from cigarettes four hours before the test.
3. On the day of the study, physical activity is prohibited.
4. Asthmatics exclude inhalation procedures.
5. The subject must not take any drugs that dilate the bronchi.
6. Avoid coffee and other caffeinated drinks.
7. Before the test, loosen clothing and its elements that restrict breathing (shirts, ties, trouser belts).
8. In addition, if necessary, follow the additional recommendations voiced by the doctor.

Research algorithm:

If there is a suspicion of an obstruction that disrupts the patency of the bronchial tree, a respiratory tract with a sample is performed.

What is this test and how is it done?

Spirometry in the classical version, gives the maximum, but incomplete idea of ​​the functional state of the lungs and bronchi. Thus, in asthma, a breath test on a machine without the use of bronchodilators, such as Ventolin, Berodual and Salbutamol, is not able to detect latent bronchospasm and it will go unnoticed.

Preliminary results are ready immediately, but their decoding and interpretation by the doctor is still to be done. This is necessary to determine the strategy and tactics of treating the disease, if any.

Deciphering the results of the FVD

After all the test events, the results are entered into the memory of the spirograph, where they are processed with the help of software and a graphic drawing is built - a spirogram.

The preliminary output compiled by the computer is expressed as follows:

• norm;
• obstructive disorders;
• restrictive violations;
• mixed ventilation disorders.

After deciphering the indicators of the function of external respiration, their compliance or non-compliance with regulatory requirements, the doctor makes a final verdict regarding the patient's health status.

The studied indicators, the rate of respiratory function and possible deviations are presented in a generalized table:

Important! When deciphering and interpreting the results of respiratory function, the doctor pays special attention to the first three indicators, because it is FVC, FEV1 and the Tiffno index that are diagnostically informative. According to the ratio between them, the type of ventilation violations is determined.

Such an unpronounceable name was given to the examination method, which allows you to measure the peak volumetric velocity during forced (maximum strength) expiration.

Simply put, this method allows you to determine the speed at which the patient exhales, applying maximum effort for this. This is how the narrowing of the airways is checked.

Peak flowmetry is especially needed by patients with asthma and COPD. It is she who is able to obtain objective data on the results of therapeutic measures.

A peak flow meter is an extremely simple device consisting of a tube with a graduated scale. How useful is it for individual use? The patient can independently take measurements and prescribe the dosage of the medications taken.

The device is so simple that even children can use it, not to mention adults. By the way, some models of these simple devices are produced especially for children.

How is peak flow measurement performed?

The testing algorithm is extremely simple:

How to interpret the data?

We remind the reader that peak flowmetry, as one of the methods for studying the respiratory function of the lungs, measures the peak expiratory flow rate (PEF). For a correct interpretation, it is necessary to determine for yourself three signal zones: green, yellow and red. They characterize a certain range of PSV, calculated according to the maximum personal results.

Let's give an example for a conditional patient, using a real technique:

1. Green Zone. In this range there are values ​​that indicate remission (weakening) of asthma. Anything above 80% PSV characterizes this condition. For example, a patient's personal record - PSV is 500 l / min. We make a calculation: 500 * 0.8 = 400 l / min. We get the lower border of the green zone.
2. yellow zone. It characterizes the beginning of the active process of bronchial asthma. Here, the lower limit will be 60% of PSV. The calculation method is identical: 500 * 0.6 = 300 l / min.
3. red zone. Indicators in this sector indicate an active exacerbation of asthma. As you understand, all values ​​below 60% of PSV are in this danger zone. In our "virtual" example, this is less than 300 l/min.

A non-invasive (without penetrating inside) method for measuring the amount of oxygen in the blood is called pulse oximetry. It is based on a computer spectrophotometric assessment of the amount of hemoglobin in the blood.

In medical practice, two types of pulse oximetry are used:

In terms of measurement accuracy, both methods are identical, but from a practical point of view, the second one is the most convenient.

Scope of pulse oximetry:

1. Vascular and plastic surgery. This method is used to saturate (saturate) oxygen and control the patient's pulse.
2. Anesthesiology and resuscitation. It is used during the movement of the patient to fix cyanosis (blue mucosa and skin).
3. Obstetrics. For fixing fetal oximetry.
4. Therapy. The method is extremely important for confirming the effectiveness of the treatment and for fixing apnea (respiratory pathology that threatens to stop) and respiratory failure.
5. Pediatrics. It is used as a non-invasive tool for monitoring the condition of a sick child.

Pulse oximetry is prescribed for the following diseases:

• complicated course of COPD (chronic obstructive pulmonary disease);
• obesity;
• cor pulmonale (enlargement and expansion of the right parts of the heart);
• metabolic syndrome (complex of metabolic disorders);
• hypertension;
• hypothyroidism (disease of the endocrine system).

Indications:

• during oxygen therapy;
• insufficient activity of breathing;
• if hypoxia is suspected;
• after prolonged anesthesia;
• chronic hypoxemia;
• in the postoperative rehabilitation period;
• apnea or prerequisites for it.

Important! With blood normally saturated with hemoglobin, the rate is almost 98%. At a level approaching 90%, hypoxia is noted. The saturation rate should be about 95%.

Study of the gas composition of the blood

In humans, the gas composition of the blood, as a rule, is stable. Shifts of this indicator in one direction or another indicate pathologies in the body.

Indications for carrying out:

1. Confirmation of a pulmonary pathology in a patient, the presence of signs of an acid-base imbalance. This is manifested in the following diseases: COPD, diabetes mellitus, chronic renal failure.
2. Monitoring the state of health of the patient after carbon monoxide poisoning, with methemoglobinemia - a manifestation in the blood of an increased content of methemoglobin.
3. Control of the patient's condition, which is connected to forced ventilation of the lungs.
4. The data is needed by the anesthesiologist before performing surgical operations, especially on the lungs.
5. Determination of violations of the acid-base state.
6. Assessment of the biochemical composition of blood.

The reaction of the body to a change in the gas components of the blood

Acid-base balance pH:

• less than 7.5 - there was a supersaturation of the body with carbon dioxide;
• more than 7.5 - the amount of alkali in the body is exceeded.

Partial pressure level of oxygen PO 2: falling below the normal value< 80 мм рт. ст. – у пациента наблюдается развитие гипоксии (удушье), углекислотный дисбаланс.

Partial (partial) pressure level of carbon dioxide PCO2:

1. The result is below the normal value of 35 mmHg. Art. - the body feels a lack of carbon dioxide, hyperventilation is not carried out in full.
2. The indicator is above the norm 45 mm Hg. Art. - there is an excess of carbon dioxide in the body, the heart rate decreases, the patient is seized by an inexplicable anxious feeling.

Bicarbonate level HCO3:

1. Below normal< 24 ммоль/л – наблюдается обезвоживание, характеризующее заболевание почек.
2. The indicator is above the normal value> 26 mmol / l - this is observed with excessive ventilation (hyperventilation), metabolic alkalosis, an overdose of steroid substances.

The study of respiratory function in medicine is the most important tool for obtaining deep generalized data on the state of the work of the human respiratory organs, the impact of which on the entire process of his life and activity cannot be overestimated.

Normal gas exchange in the lungs is ensured by adequate perfusion

ventilation ratio. In turn, pulmonary ventilation depends on the condition of the lung tissue, chest and pleura (static characteristics), as well as on the patency of the airways (dynamic characteristics).

The static parameters of pulmonary ventilation include

the following indicators:

1. Tidal volume (TO) - the amount of inhaled and exhaled air during quiet breathing. Normally, it is 500-800 ml.

2. Inspiratory reserve volume (IRV) is the volume of air that a person can inhale after a normal breath. Normally, it corresponds to 1500-2000 ml.

3. Expiratory reserve volume (ERV) is the volume of air that a person can exhale after a normal exhalation. Normally, it usually corresponds to 1500-2000 ml.

4. Vital capacity (VC) - the volume of air that a person can exhale after a maximum breath. Usually it is 300-5000 ml.

5. Residual lung volume (RLV) - the volume of air remaining in the lungs after maximum exhalation. Usually it corresponds to 1500 ml.

6. Inspiratory capacity (EVD) - the maximum volume of air that a person can inhale after a quiet exhalation. It includes DO and ROVD.

7. Functional residual capacity (FRC) - the volume of air contained in the lungs at the height of maximum inspiration. It includes the amount of OOL and ROvyd.

8. Total lung capacity (TLC) - the volume of air contained in the lungs at the height of maximum inspiration. It includes the sum of OOL and VC.

Dynamic parameters include the following speed indicators:

1. Forced vital capacity (FVC) - the amount of air that a person can exhale at maximum speed after a maximum deep breath.

2. Forced expiratory volume in 1 second (FEV1) - the amount of air that a person can exhale in 1 second after a deep breath. Usually this indicator is expressed in % and it averages 75% of VC.

3. The Tiffno index (FEV1 / FVC) is indicated in% and reflects both the degree of obstructive pulmonary ventilation disorders (if less than 70%) and restrictive (if more than 70%).

4. The maximum volumetric velocity (MOV) reflects the maximum volumetric forced expiratory velocity averaged over a period of 25-75%.

5. Peak expiratory flow rate (PSV) - the maximum volumetric forced expiratory flow rate, usually determined on a peak flow meter.

6. Maximum ventilation of the lungs (MVL) - the amount of air that a person can inhale and exhale with a maximum depth in 12 seconds. Expressed in l/min. Typically, MVL averages 150 l / min.

The study of static and dynamic indicators is usually carried out using the following methods: spirography, spirometry, pneumotachometry, peak flowmetry.

In pathology, two main types of pulmonary ventilation disorders are distinguished: restrictive and obstructive.

The restrictive type is associated with impaired respiratory excursion of the lungs, which is observed in diseases of the lungs, pleura, chest and respiratory muscles. The main indicators in the restrictive type of ventilation disorders include VC, which also allows you to monitor the dynamics of restrictive pulmonary disease and the effectiveness of treatment; OEL, FOE, DO, ROVD. In pathology, these indicators decrease.

The obstructive type of impaired lung ventilation is associated with a violation of the passage of air flow through the respiratory tract. This may be due to the narrowing of the airways and an increase in aerodynamic resistance, due to the accumulation of secretions in bronchitis and bronchiolitis, swelling of the bronchial mucosa, spasm of the smooth muscles of the small bronchi (bronchial asthma), early expiratory collapse of the small bronchi in emphysema, laryngeal stenosis.

The main indicators reflecting the obstructive type of ventilation impairment: FEV1; Tiffno index, maximum expiratory flow rate at 25%, 50% and 75%; FVC, peak expiratory flow in pathology are reduced.

First day in the hospital. Went in for an appointment. department of pulmonology. The interrogation was too banal. Are there seizures? Of course yes! And everything like that. Plus a verbatim description of the anamnesis. After that, they tell me, they say tomorrow you will go for spirography, pass tests, go to Laura. Anyway, I left the office in a flurry.

Second day. In the morning I donated blood, urine, blood from a vein for allergens. I did not notice how the most terrible and exciting moment approached. I'm sitting in line for a spirography. I read a lot of advice, about the fact that you need to breathe through the tongue, etc. I sit and train. And then, as God himself sent me an idea, 5 minutes before entering the office. Whether I myself invented this technique ... is unclear. In a word, I decided to breathe "through the stomach", i.e. try to breathe classically first, and then tighten your stomach as if you want to show off your abs, and breathe with a tense stomach. The difference is palpable. The time has come to test the technique in practice. I breathe, the nurse does not find fault with anything. With a bronchodilator, I breathe a little better. Here, the conclusion is already being printed, and what do I see? Conclusion: The lung volume was reduced by almost 50%, bronchospasm was recorded. To celebrate, I leave the office and go home.

The third day in the hospital, I got up without mood, with great excitement I come to the hospital, the nurse hands an extract that says: "Diagnosis: Bronchial asthma, atopic form, mild course, subremission." + the nurse adds, we have already sent the act, good luck. Almost jumping out of the hospital.

The next morning, I am in RVC, straight to the chapters. the doctor, I hand over the extract, + a copy of which he assured me. “Congratulations on demobilization,” he said, it just overwhelms me, I say: “Thank you, thank you.” He puts the category "B", orders to appear at the transit point in 2 weeks. Two weeks passed, he appeared, the military commissar signed all the papers, saying: “In a month and a half you will pick up a military ID”, now I am sitting in anticipation of the cherished red book.

» How to breathe properly

Preparation for the study of respiratory function

Examination of respiratory function (functions of external respiration)- SPIROMETRY - the study of the functional state of the lungs contributes to the early detection of pulmonary diseases, establishes the presence and cause of bronchospasm.

To clarify and determine the severity of bronchospasm, the mechanisms of its occurrence, the selection of medications and the evaluation of the effectiveness of treatment, bronchodilator tests are performed.

Spirometry allows you to evaluate:

• functional state of the lungs and bronchi (in particular, the vital capacity of the lungs) -
• airway patency
• detect obstruction (bronchospasm)
• the severity of pathological changes.

With spirometry you can:

• Accurately detect latent bronchospasm (the main symptom of formidable lung diseases - bronchial asthma and chronic obstructive bronchitis)
• to make an accurate differential diagnosis between these diseases
• assess the severity of the disease
• choose the optimal treatment strategy
• determine the effectiveness of ongoing therapy in dynamics.

This study also allows us to solve the fundamental question of the reversibility (reversible or partially reversible) of bronchial obstruction. For this, special tests are carried out with inhalation of bronchodilator drugs.

The data of FVD (spirometry) help at the modern level to select individually optimal bronchodilator therapy and evaluate the effect of the treatment and rehabilitation measures.

Spirometry should be done if you have:

• prolonged and prolonged causeless cough (for 3-4 weeks or more, often after acute respiratory viral infections and acute bronchitis);
• there is shortness of breath, a feeling of congestion in the chest;
• wheezing and wheezing occurs mainly during exhalation;
• there is a feeling of difficulty exhaling and inhaling.

Spirometry is advisable to carry out regularly if you:

• you are a smoker with many years of experience;
• suffer from frequent exacerbations of bronchitis or experience shortness of breath, a feeling of lack of air;
• have a heredity burdened by diseases of the respiratory system or allergic diseases;
• need to correct the therapy of bronchial asthma;
• are forced to breathe polluted and dusty air (when working in hazardous industries)

The study of respiratory function is started in the morning on an empty stomach or not earlier than 1-1.5 hours after a meal.

Before the study, nervous, physical overstrain, physiotherapy, smoking are prohibited. The FVD examination is carried out in a sitting position. The patient performs several breathing maneuvers, after which computer processing is carried out and the results of the study are issued.

1. Chronic diseases of the broncho-pulmonary system (chronic bronchitis, pneumonia, bronchial asthma)
2. Diseases that primarily affect the vessels of the lungs (primary pulmonary hypertension, pulmonary arteritis, pulmonary thrombosis).
3. Thoraco-diaphragmatic disorders (postural disorders, kyphoscoliosis, pleural folds, neuromuscular paralysis, obesity with alveolar hypoventilation).
4. neurosis and thyrotoxicosis.
5. The study of the function of external respiration (spirometry) can be carried out:

• when hiring with harmful working conditions;
• patients who are planned for surgical treatment with intubation anesthesia;
• patients with diseases of various organs and systems and with complaints of shortness of breath.
• at screening - for early detection of restrictive and obstructive changes;

1. Acute diseases of the broncho-pulmonary system (acute bronchitis, acute pneumonia, acute respiratory disease, lung abscess (accompanied by a pronounced cough reflex and copious sputum);
2. Exacerbation of chronic broncho-pulmonary disease. an attack of bronchial asthma.
3. Infectious diseases, including tuberculosis

• young children;
• hearing impaired patients;
• patients with mental disorders;
• patients over 75 years of age;
• patients with epilepsy.

This type of diagnostic procedure is widely used in modern medicine. There are several reasons for this: firstly, the procedure does not take much time, secondly, it is completely painless, and thirdly, it gives accurate results and helps plan further treatment.

The function of external respiration- a type of diagnostic study that allows you to determine the ventilation capacity of the lungs.

FVD is a universal method of examination for all pulmonary diseases. Given the high accuracy of the results and the speed of the study, it is possible to prescribe the necessary treatment or determine the cause of the deterioration in the shortest possible time. Spirometry is a mandatory research method in the following cases:

• Dyspnea;
• Attacks of suffocation;
• chronic cough;
• COPD;
• Chronical bronchitis;
• Bronchial asthma.

The assessment of the ventilation capacity of the lungs is checked by a special device - a spirometer. Several types of tests are performed. Based on the results obtained, the level of bronchial sensitivity, bronchial patency, and reversibility of bronchial obstruction are determined.

The research takes place in several stages:

• With calm breathing;
• During forced exhalation;
• Maximum ventilation;
• functional tests.

The function of external respiration allows you to accurately determine the current state of the bronchi and lungs, assess the patency of the airways, identify pathological changes and determine the degree of their complexity.

When conducting FVD at regular intervals, it is possible to establish the effectiveness of the treatment, adjust the methods of therapy. In some cases, preventive sessions of respiratory function help in time to prevent the progression of an existing disease or the development of a concomitant one.

Despite the information content of the method, its implementation is not always possible. Only a therapist can determine the need for spirometry. If the patient's state of health does not allow for FVD, the attending physician finds alternative, more gentle methods of diagnosis.

• myocardial infarction;
• General serious condition;
• Heart failure in a complex form;
• Claustrophobia;
• Tuberculosis;
• Mental disorders.

Please do not self-medicate!
Remember, only a doctor can determine the diagnosis and correctly prescribe treatment.

Vershuta Elena Vasilievna

Therapist, cardiologist, doctor of functional diagnostics. K.M.N.

Khegay Svetlana Viktorovna

Therapist, K.M.N. docent

Chernenko Oksana Alexandrovna

Therapist, cardiologist, doctor of functional diagnostics of the first category

Chumakova Irina Pavlovna

Therapist of the highest category

Manipulation. Examination of the function of external respiration

Breathing is made up of external respiration, transport of gases by blood and tissue respiration(use of oxygen for cell metabolism).

external respiration- exchange of gases between atmospheric air and blood. It is made up of ventilation, diffusion and perfusion.

Ventilation(ventilation) - the movement of air through the bronchi.

Diffusion- gas exchange through the air-blood barrier (blood gives off carbon dioxide and is saturated with oxygen).

Perfusion- the movement of blood through the vessels of the lung.

Examination of the function of external respiration(FVD)- a method for assessing the condition of the respiratory tract and lungs. This method studies ventilation only.

The function of external respiration studied with spirometry,spirography, pneumotachometryand pneumotachography.

Preparing the patient for the study of FVD

Purpose of the study - diagnosis of broncho-obstructive syndrome and other pathology of BLS.

FVD study provides an objective assessment bronchial obstruction, and the measurement of its fluctuations - bronchial hyperreactivity.

INDICATIONS: COB, COPD, bronchial asthma, other diseases of BLS.

CONTRAINDICATIONS: severe circulatory failure, cardiac arrhythmia, angina attack, myocardial infarction, pulmonary tuberculosis, mental disorders.

The FVD study is performed by a doctor in the office functional diagnostics. He also explains the course of the procedure to the patient, informs about possible complications, convinces of its necessity and obtains the consent of the patient.

The role of the nurse: 1. make sure that the patient's consent is obtained, 2. issue a referral, 3. transport or accompany the patient to the office and back, 4. place the result of the study in the medical history, 5. monitor the patient's condition after the examination during the day, report on deterioration doctor.

Training: the patient on the day of the study is on the usual water and food regimen. The study is carried out 2 hours after eating. On this day, all diagnostic and therapeutic procedures and medications are canceled, except for those necessary for health reasons, neuropsychic stress. Smoking is prohibited. Before the study, it is necessary to empty the intestines and bladder.

Technique. The patient is seated on a chair in front of the device. At the doctor's command, the patient breathes through a special tube, air enters the breathing circuit, and the device analyzes pulmonary ventilation. If necessary, tests with bronchodilators are carried out. The patient must and clearly follow all the doctor's commands: breathe with effort, hold your breath, etc.

The duration of the study is no more than an hour.

The conclusion on the results of the study is issued in 15-30 minutes.

Complications: deepening of bronchial obstruction.

Ventilation rates in healthy people

(A) tidal volumes

Tidal volume (DO) - the volume of 1 inhalation and exhalation at rest - 0.3-0.8 l,

Inspiratory reserve volume (RO VD) - maximum inhalation volume after a normal inhalation - 1.2-2l,

Expiratory reserve volume (RO vyd) - the maximum expiratory volume after a normal exhalation - 1-1.5 l,

Vital capacity of the lungs (VC) - the volume of maximum expiration following the maximum inspiration = DO + RO VD + RO EX = 15-20% + 50% + 30% VC = 3-5l,

Residual lung volume (RLV) - the air remaining in the lungs after maximum expiration - 1-1.5 liters or 20-30% of the VC,

Total lung capacity (OLL) - 4-6.5l \u003d VC + OOL,

(B) intensity of pulmonary ventilation

Minute breathing volume (MOD) - TO ´ BH = 4-10l,

Maximum lung ventilation (MVL) - breathing limit - the amount of air that can be ventilated by the lungs with the deepest possible breathing at a frequency of 50 / min - 50-150l / min,

Forced expiratory volume in 1 second (FEV 1) - more than 65% VCL,

Forced vital capacity (FVC) - maximum exhalation followed by maximum inspiration with the most possible force and speed - more than VC by 8-11%,

The Tiffno index - the ratio of FEV 1 to FVC and multiplied by 100 - is greater than or equal to 70%.

criterion reversible bronchial obstruction is an increase in FEV 1 (more than 12%) after inhalation of short-acting beta-2 agonists. In severe asthma, a loss of the elastic properties of the lungs is detected, the phenomenon of an air trap, an increase in the residual volume, can be observed. Falling FVC/VC ratio is a risk factor for fatal asthma.

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In modern medicine, in patients of various ages with symptoms of respiratory diseases, one of the main diagnostic methods is the method of studying the function of external respiration (RF). This research method is the most accessible and allows assessing the ventilation functionality of the lungs, i.e. their ability to provide the human body with the necessary amount of oxygen from the air and remove carbon dioxide.

1 Vital capacity of lungs

For a quantitative description, the total lung capacity is divided into several components (volumes), i.e. lung capacity is a collection of two or more volumes. Lung volumes are divided into static and dynamic. Static are measured during completed respiratory movements without limiting their speed. Dynamic volumes are measured when performing respiratory movements with a temporary restriction on their implementation.

Vital capacity (VC) includes: tidal volume, expiratory reserve volume, and inspiratory reserve volume. Depending on gender (male or female), age and lifestyle (sports, bad habits), the norm varies from 3 to 5 (or more) liters.

Depending on the method of determination, there is:

• Inhalation VC - at the end of a full exhalation, a maximum deep breath is taken.
• Expiratory VC - at the end of inhalation, maximum exhalation is carried out.

Tidal volume (TO, TV) - the volume of air inhaled and exhaled by a person during quiet breathing. The value of the tidal volume depends on the conditions under which measurements are performed (at rest, after exercise, body position), sex and age. The average is 500 ml. It is calculated as an average after measuring six even, normal for a given person, respiratory movements.

Inspiratory reserve volume (IRV, IRV) is the maximum amount of air that can be inhaled by a person after his usual breath. The average value is from 1.5 to 1.8 liters.

Expiratory reserve volume (ERV) is the maximum volume of air that can be exhaled additionally by making your normal exhalation. The size of this indicator is smaller in a horizontal position than in a vertical one. Also, expiratory RO decreases with obesity. On average, it is from 1 to 1.4 liters.

What is spirometry - indications and diagnostic procedures

2 Examination of respiratory function

Determination of indicators of static and dynamic lung volumes is possible when conducting a study of the function of external respiration.

Static lung volumes: tidal volume (TO, TV); expiratory reserve volume (RO vyd, ERV); inspiratory reserve volume (RO vd, IRV); vital capacity of the lungs (VC, VC); residual volume (C, RV), total lung capacity (TLC, TLC); airway volume ("dead space", MT on average 150 ml); functional residual capacity (FRC, FRC).

Dynamic lung volumes: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), Tiffno index (FEV1 / FVC ratio, expressed as a percentage), maximum lung ventilation (MVL). The indicators are expressed as a percentage of the values ​​determined individually for each patient, taking into account his anthropometric data.

The most common method for studying the respiratory function is considered to be the method, which is based on the recording of the flow-volume curve during the implementation of enhanced exhalation of the vital capacity of the lungs (FVC). The capabilities of modern instruments make it possible to compare several curves; based on this comparison, it is possible to determine the correctness of the study. The correspondence of the curves or their close location indicates the correct performance of the study and well-reproducible indicators. When performing enhanced exhalation is done from the position of maximum inspiration. In children, unlike the study technique in adults, the expiration time is not set. Forced exhalation is a functional load on the respiratory system, therefore, between attempts, you should take breaks of at least 3 minutes. But even under these conditions, there may be obstruction from spirometry, a phenomenon in which, with each subsequent attempt, there is a decrease in the area under the curve and a decrease in the recorded indicators.

The unit of measurement of the obtained indicators is a percentage of the due value. Evaluation of the data of the flow-volume curve allows you to find possible violations of bronchial conduction, assess the severity and extent of the identified changes, determine at what level changes in the bronchi or violations of their patency are noted. This method allows to detect lesions of small or large bronchi or their joint (generalized) disorders. Diagnosis of patency disorders is performed based on the assessment of FVC and FEV1 and indicators characterizing the speed of air flow through the bronchi (maximum high-speed flows in areas of 25.50 and 75% FVC, peak expiratory flow).

Difficulties in the examination are presented by the age group - children aged 1 to 4 years, due to the peculiarities of the technical part of the study - the performance of respiratory maneuvers. Based on this fact, the assessment of the functioning of the respiratory system in this category of patients is based on an analysis of clinical manifestations, complaints and symptoms, an assessment of the results of the analysis of the gas composition and CBS, arterialized blood. In connection with the presence of these difficulties, in recent years, methods based on the study of calm breathing have been developed and are actively used: bronchophonography, pulse oscillometry. These methods are intended mainly for the evaluation and diagnosis of the patency of the bronchial tree.

General and clinical signs of bronchial asthma

3 Test with bronchodilator

When deciding whether to make a diagnosis of "bronchial asthma" or clarify the severity of the condition, a test (test) with a bronchodilator is performed. For carrying out, short-acting β2 agonists (Ventolin, Salbutamol) or anticholinergic drugs (Ipratropium bromide, Atrovent) are usually used in age dosages.

If the test is planned for a patient who receives bronchodilators as part of the basic therapy, for proper preparation for the study, they should be canceled before the start of the study. Short-acting B2-agonists, anticholinergic drugs are canceled within 6 hours; long-acting β2-agonists are canceled per day. If the patient is hospitalized for emergency indications and bronchodilators have already been used at the stage of pre-hospital care, the protocol must indicate which drug was used in the study. Carrying out a test while taking these drugs can “deceive” a specialist and lead to an incorrect interpretation of the results. Before conducting a test with a bronchodilator for the first time, it is necessary to clarify the presence of contraindications to the use of these groups of drugs in a patient.

The algorithm for conducting a sample (test) with a bronchodilator:

• a study of the function of external respiration is performed;
• inhalation with a bronchodilator is carried out;
• re-examination of the function of external respiration (the dosage and time interval after inhalation to measure the bronchodilatory response depend on the selected drug).

At the moment, there are different approaches to the methodology for evaluating the results of a test with a bronchodilator. The most widely used assessment of the result is an unconditional increase in the FEV1 indicator. This is explained by the fact that when studying the characteristics of the flow-volume curve, this indicator turned out to have the best reproducibility. An increase in FEV1 by more than 15% of the initial values ​​is conditionally characterized as the presence of reversible obstruction. Normalization of FEV1 in the test with bronchodilators in patients with chronic obstructive pulmonary disease (COPD) occurs in rare cases. A negative result in the test with a bronchodilator (an increase of less than 15%) does not negate the possibility of an increase in FEV1 by a large amount during long-term adequate drug therapy. After a single test with β2-agonists, a third of patients with COPD showed a significant increase in FEV1, in other groups of patients this phenomenon can be observed after several tests.

Algorithm for first aid for an attack of bronchial asthma

4 Peak flow

This is the measurement of peak expiratory flow (PEF, PEF) using portable devices at home in order to monitor the patient's condition with bronchial asthma.

For the study, the patient needs to inhale the maximum possible volume of air. Next, the maximum possible exhalation into the mouthpiece of the device is performed. Usually three measurements are taken in a row. For registration, the measurement with the best result of the three is selected.

The limits of the norm of peak flowmetry indicators depend on the sex, height and age of the subject. Recording of indicators is carried out in the form of a diary (graph or table) of peak flow measurements. Twice a day (morning / evening), the indicators are entered in the diary as a point corresponding to the best of three attempts. Then these points are connected by straight lines. Under the graph, a special field (column) for notes should be allocated. They indicate the medications taken over the past day, and factors that could affect the person's condition: weather changes, stress, the addition of a viral infection, contact with a large amount of a causally significant allergen. Regular filling in the diary will help to identify in a timely manner what caused the deterioration of well-being and evaluate the effect of drugs.

Bronchial patency has its own daily fluctuations. In healthy people, fluctuations in PSV should not be more than 15% of the norm. In people with asthma, fluctuations during the day during the period of remission should not be more than 20%.

The system of zones on the peak flow meter is based on the principle of a traffic light: green, yellow, red:

• Green zone - if the PSV values ​​are within this zone, they talk about clinical or pharmacological (if the patient uses drugs) remission. In this case, the patient continues the drug therapy regimen prescribed by the doctor and leads his usual lifestyle.
• The yellow zone is a warning about the beginning of a possible deterioration in the condition. When lowering PSV values ​​within the boundaries of the yellow zone, it is necessary to analyze the diary data and consult a doctor. The main task in this situation is to return the indicators to the values ​​in the green zone.
• The red zone is a danger signal. You need to contact your doctor immediately. There may be a need for urgent action.

Adequate control over the condition allows you to gradually reduce the amount of drug therapy used, leaving only the most necessary drugs in minimal dosages. The use of a traffic light system will allow timely detection of health-threatening disorders and help prevent unplanned hospitalization.

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Diagnostics

Precision equipment
Modern research methods

Examination of the function of external respiration

Prices for the study of the function of external respiration

The study of external respiration is carried out by three methods: Spirography, Body plethysmography, Diffusion ability of the lungs.

Spirography- basic study of the function of external respiration. As a result of the study, they get an idea of ​​the presence or absence of violations of bronchial patency. The latter arise as a result of inflammatory processes, bronchospasm, and other causes. Spirography allows you to determine how pronounced the changes in bronchial patency are, at what level the bronchial tree is affected, how pronounced the pathological process is. Such data are necessary for the diagnosis of bronchial asthma, chronic obstructive pulmonary disease and some other pathological processes. Spirography is performed for the selection of therapy, control over treatment, selection for sanatorium treatment, determination of temporary and permanent disability.

In order to determine how reversible the pathological process is, functional tests are used to select treatment. At the same time, a spirogram is recorded, then the patient inhales (inhales) a medicine that expands the bronchi. After that, the spirogram is recorded again. Comparison of data before the use of the drug and obtained after its use, allows us to conclude that the pathological process is reversible.

Often, spirography is performed on healthy people. This is necessary in the implementation of professional selection, for planning and performing training sessions that require tension in the respiratory system, confirmation of the fact of health, etc.

Spirography provides valuable information about the state of the respiratory system. Often, spirography data need to be confirmed by other methods, or to clarify the nature of the changes, to identify or refute the assumption of lung tissue involvement in the pathological process, to detail the idea of ​​the state of metabolism in the lungs, etc. In all these and other cases, body plethysmography is used and carried out study of the diffusion capacity of the lungs.

Body plethysmography - if necessary, performed after a basic study - spirography. The method with high accuracy determines the parameters of external respiration, which cannot be obtained by conducting only one spirography. These parameters include determination of all lung volumes, capacities, including total lung capacity.

The study of the diffusion capacity of the lungs is performed after spirography and body plethysmography to diagnose emphysema (increased airiness of the lung tissue) or fibrosis (compaction of the lung tissue due to various diseases - broncho-pulmonary, rheumatic, etc.). In the lungs, gases are exchanged between the internal and external environment of the body. The entry of oxygen into the blood and the removal of carbon dioxide is carried out by diffusion - the penetration of gases through the walls of capillaries and alveoli. The conclusion about how efficiently gas exchange proceeds can be drawn from the results of a study of the diffusion capacity of the lungs.

Why it is worth doing in our clinic

Often, the results of spirography require clarification or detail. FSCC FMBA of Russia has special devices. These devices allow, if necessary, to carry out additional studies and clarify the results of spirography.

Spirographs, which our clinic has, are modern, allow in a short time to obtain many parameters for assessing the state of the external respiration system.

All studies of the function of external respiration are performed on a multifunctional installation of the expert class Master Screen Body Erich-Jäger (Germany).

Indications

Spirography is performed to establish the fact of health; establishing and clarifying the diagnosis (bronchitis, pneumonia, bronchial asthma, chronic obstructive pulmonary disease); preparation for surgery; selection of treatment and control of ongoing treatment; assessment of the patient's condition; clarifying the causes and forecasting the timing of temporary disability and in many other cases.

Contraindications

Early (up to 24 hours) postoperative period. Contraindications are determined by the attending physician.

Methodology

The subject performs various breathing maneuvers (calm breathing, deep inhalation and exhalation), following the instructions of the nurse. All maneuvers must be performed carefully, with the right degree of inhalation and exhalation.

Training

The attending physician may cancel or limit the intake of certain medications (inhalation, tablets, injections). Before the study (at least 2 hours) smoking stops. Spirography is best done before breakfast, or 2 to 3 hours after a light breakfast. It is advisable to be at rest before the study.

- a method for determining lung volumes and capacities when performing various respiratory maneuvers (measuring VC and its components, as well as FVC and FEV

Spirography- a method of graphic registration of changes in lung volumes and capacities during quiet breathing and performing various respiratory maneuvers. Spirography allows you to evaluate lung volumes and capacities, indicators of bronchial patency, some indicators of pulmonary ventilation (MOD, MVL), oxygen consumption by the body - P0 2.

In our clinic, the diagnosis of the function of external respiration (spirometry) is performed on a modern software and hardware complex. The diagnostic device, the sensor of which is equipped with a disposable interchangeable mouthpiece, measures the speed and volume of your exhaled air in real time. The data from the sensor enters the computer and is processed by a program that captures the slightest deviations from the norm. Then the doctor of functional diagnostics evaluates the initial data and the product of the computer analysis of the spirogram, correlates them with the data of previously performed studies and the individual characteristics of the patient. The results of the study are reflected in a detailed written conclusion.

For a more accurate diagnosis, usebronchodilator test. Breathing parameters are measured before and after inhalation of the bronchodilator drug. If initially the bronchi were narrowed (spasmodic), then during the second measurement, against the background of the action of inhalation, the volume and speed of exhaled air will increase significantly. The difference between the first and second study is calculated by the program, interpreted by the doctor and described in the conclusion.

Study preparation functions of external respiration (spirometry)

• Do not smoke or drink coffee 1 hour before the examination.
• Light food intake 2-3 hours before the study.
• Cancellation of drugs (on the recommendation of a doctor): short-acting b2-agonists (salbutomol, ventolin, berodual, berotek, atrovent) - 4-6 hours before the study; b2-agonists of prolonged action (salmeterol, formoterol) - for 12 hours; prolonged theophyllines - for 23 hours; inhaled corticosteroids (seretide, symbicort, beclazone) - for 24 hours.
• Bring your medical card with you.

Indications for the study of the function of external respiration (spirometry):

1. Diagnosis of bronchial asthma and chronic obstructive pulmonary disease (COPD). Based on the data of respiratory function and laboratory tests, it is possible to confirm or reject the diagnosis with confidence.

2. Evaluation of the effectiveness of treatment by changes in the spirogram helps us choose exactly the treatment that will have the best effect.

FVD determines how much air enters and exits your lungs and how well it moves. The test checks how well your lungs are working. It may be done to check for lung disease, response to treatment, or to determine how well the lungs are working before surgery.

Terms and conditions for spirometry

1. It is advisable to conduct the study in the morning (this is the best option), on an empty stomach or 1-1.5 hours after a light breakfast.
2. Before the test, the patient should be at rest for 15-20 minutes. All factors that cause emotional arousal should be excluded.
3. The time of day and year should be taken into account, since people suffering from pulmonary diseases are more susceptible to daily fluctuations in indicators than healthy people. In this regard, repeated studies should be carried out at the same time of day.
4. The patient should not smoke for at least 1 hour before the examination. It is useful to record the exact timing of the last cigarette and drug intake, the degree of patient-operator cooperation, and some adverse reactions such as coughing.
5. Measure the subject's weight and height without shoes.
6. The patient should be thoroughly explained the procedure for the study. At the same time, it is necessary to focus on preventing air from leaking into the environment past the mouthpiece and applying maximum inspiratory and expiratory efforts during the corresponding maneuvers.
7. The study should be performed on the patient in an upright sitting position with a slightly raised head. This is due to the fact that lung volumes are highly dependent on body position and are significantly reduced in a horizontal position compared to a sitting or standing position. The chair for the subject should be comfortable, without wheels.
8. As the exhalation maneuver is performed until the OOL is reached, forward tilts of the body are undesirable, since this causes compression of the trachea and contributes to the ingress of saliva into the mouthpiece, head tilts and neck flexion are also undesirable, as this changes the viscous-elastic properties of the trachea.
9. Since the chest must be able to move freely during respiratory maneuvers, tight clothing must be unbuttoned.
10. Dental prostheses, except for very loose ones, should not be removed prior to examination, as the lips and cheeks lose their support, allowing air to leak past the mouthpiece. The latter should be captured by teeth and lips. It is necessary to ensure that there are no cracks in the corners of the mouth.
11. A clamp is put on the patient's nose, which is necessary for measurements performed with quiet breathing and maximum ventilation of the lungs in order to avoid air leakage through the nose. It is difficult to exhale (partially) through the nose during the FVC maneuver, but it is recommended to use a nose clip during such maneuvers, especially if the forced expiratory time is significantly prolonged.

Close interaction and mutual understanding between the nurse conducting the study and the patient is very important. poor or incorrect execution of maneuvers will lead to erroneous results and an incorrect conclusion.