Exp er ime nt No .

23
Effect of Surface Tension on
Compliance
Ob je ctive

 To determine the effect of surface

tension on lung compliance
Eq uipment

 Two balloons
 Tap water
 Graduated cylinder
Me thodolo gy

1. Fill up one balloon with water. In the

second balloon, pour 10cc. of water
and partially inflate it with air until its
size is similar to the first balloon.
2. After maximal expiration, exhale forcibly
into the first balloon.
3. Repeat step 2, with the second balloon
partially filled with water.
Re su lt s

Male
Balloon A Balloon B

Original 16cm 16cm

Circumference

After Maximal 49cm 53cm

Expiration
Re su lt s

Female
Balloon A Balloon B

Original 16cm 16cm

Circumference

After Maximal 43cm 47cm

Expiration
Re su lt s

 After maximal expiration on both

balloons, the balloon filled water is
smaller than the balloon with only 10cc.
of water.
Disc ussio n
 The greater the amount of water, the higher the
surface tension exhibited on a system.
 High surface tension in the lungs would
increase the inspiratory pressure needed for
the lungs to expand.
 Elasticity affects lung compliance just like the
elasticity of the rubber balloon when inflated.
Co nclusion

Based on the result of the experiment,

higher amount of water on a system
would increase its surface tension, and
therefore decreasing its compliance.
Qu estio ns

1. Define the following:

Lung Compliance
- refers to the distensibility of the lung
and is defined as the change in volume
of that structure produced by a change
in pressure across the structure.
Qu estio ns
1. Define the following:
Lung Elasticity
- it is the ability of the lung to oppose stress
The lungs have inward elastic force. The
force is larger when the lungs are increased
in volume. The elastic force of the lungs is
larger when the lungs are increased in
volume. The elastic force of the lungs is
smaller when the lungs are decreased in
volume.
Qu estio ns

2. What is the effect of filling up the

balloon with water?
The water increases the surface
tension inside the balloon, thus,
decreasing the ability of the balloon to
expand when a pressure is applied to it.
Qu estio ns
3. Explain the effect of surface tension on lung
compliance.
A high surface tension decreases lung
compliance. A larger pressure is needed to
distend the lungs, this is because the
interaction between the liquid surface must
first be overcome to lessen the surface
tension within the lungs and finally distend
the lungs. Thus, to achieve the same volume
of a lung with normal surface tension a higher
pressure must be exerted.
Qu estio ns

4. Give some conditions that can affect

compliance.
Emphysema
Cystic Fibrosis
Respiratory Distress Syndrome
Qu estio ns
Emphysema
-dilation of the alveolar spaces
and destruction of the alveolar
walls, thus lung elastic recoil is
lost
-the lung becomes easy to
distend but empties slowly,
which results in a chronically
overinflated lung (high total lung
capacity, functional residual
capacity, and residual volume),
which lessens the curvature of
the diaphragm, making it less
efficient in generating even the
small swings in pleural pressure
necessary for breathing
- the lung is highly compliant
Qu estio ns
Cystic Fibrosis
-the lungs become stiff, making a
large pressure necessary to maintain
a moderate volume.
- lung poorly compliant
Qu estio ns
Respiratory Distress Syndrome
- lung surfactant, which is
responsible for decreasing
surface tension in the lungs,
is deficient at birth cause
diffuse lung atelectasis
(failure of lung to expand)
- the lung has decrease
compliance
Exp er ime nt no .
24
Respiratory Movements in Man
Ob je ctive s

 To determine the changes in chest

circumference at the level of the axilla
and xiphoid during inspiration and
expiration

 To determine and compare the breaking

points of the subjects at various
conditions
Me thodolo gy

 Chest Measurement
1. Using a tape measure, get the chest
circumference at the level of the axilla
during:
a. The end of quiet expiration
b. The end of normal inspiration
c. The end of the most forceful expiration possible
d. The end of the most forceful inspiration
possible
Me thodolo gy

 Chest Measurement
1. Using a tape measure, get the chest
circumference at the level of the xiphoid
process during:
a. The end of quiet expiration
b. The end of normal inspiration
c. The end of the most forceful expiration possible
d. The end of the most forceful inspiration
possible
Me thodolo gy

 Breaking Point
1. After normal inspiration, make the subject
hold his breath until he can no longer hold
it. Record the duration.
2. After a deep expiration, make the subject
hold his breath until he can no longer hold
it. Record the duration.
Me thodolo gy

 Breaking Point
1. After taking deep breaths from a brown
paper bag, make the subject hold his
breath at the end of inspiration until he can
no longer hold it. Record the duration.
2. After a full minute of deep breathing, make
the subject hold his breath at the end of
deep inspiration until he can no longer hold
it. Record the duration.
Re su lt s
Table 1. Chest circumference of the subjects

Condition Chest measurement (cm)

Male subject Female subject

Axilla level Xiphoid level Axilla level Xiphoid level

Normal 92 87 73.75 64.75

End of quiet 90 85 73.25 65.

expiration

End of normal 94 89 74.5 65.25

inspiration

End of forceful 87.5 82.5 72.75 63.75

expiration

End of forceful 96.5 91.5 76.25 67.5

inspiration
Re su lt s
Table 2. Breaking points of the subjects

Breaking point condition Duration (seconds)

Male subject Female subject

End of normal inspiration 36.46 27

End of deep expiration 20.53 24

End of inspiration after deep 83.86 87

breathing from a bag

End of inspiration after deep 109.13 37

breathing for 1 minute
Disc ussio n
Quiet Inspiration
 Diaphragm contracts
 Diaphragm descends into abdomen  Abdominal viscera
descend  Increases vertical diameter of thorax
 Elevates lower ribs  Elevates body of sternum and upper ribs
 Elevation of 3rd, 4th, 5th, and 6th ribs  increase in antero-posterior
and transverse diameters of the thorax
 Elevation of 8th, 9th, and 10th ribs  increase in transverse diameter
of upper abdomen
o 1st and 2nd ribs  fixed by resistance of shoulder girdle
o 11th and 12th ribs  fixed by Quadratus lumborum muscle

 External intercostal muscles contract

 External intercostals elevate rib cage  Sternum moves
anteriorly
Quiet Expiration
 Diaphragm relaxes
 Diaphragm moves superiorly  Abdominal viscera ascend 
Decreases vertical diameter of thorax
 Returns lower ribs to resting position

 External intercostal muscles relax

 External intercostals relax  Rib cage and sternum return to
resting position
Muscles of Deep Respiration
Deep Inspiration
 All movements of quiet inspiration but to a greater extent
 Scalenes and sternocleidomastoids draw up the sternum
and clavicles  All ribs except 11th and 12th are raised to
a higher level
 Anterior abdominal muscles (Rectus abdominis, Internal
and external obliques, transversus abdominis) are
stretched  Umbilicus is drawn upward  Increases
transverse diameter of upper abdomen
 Serratus posterior superior and sacrospinales
straightens thoracic curve of vertebral column 
Increases antero-posterior diameters of thorax and
upper abdomen; Widens intercostal spaces
Deep Expiration
 All movements of quiet expiration but to a greater extent
 Anterior abdominal muscles contract  Umbilicus
shortens  Decreases transverse diameter of upper
abdomen
 Serratus posterior inferior and transversus thoracis
affects thoracic curve of vertebral column  Decreases
antero-posterior diameters of thorax and upper
abdomen; Intercostal spaces narrow
 Also affected by recoil of thoracic walls
Co ntr ol o f Ve ntila tion
 Inc. CO2 or decreased O2 levels induce
the respiratory center in the brain to
induce respiration
 Central chemoreceptors in the medulla
are stimulated by PCO2 and the pH of
arterial blood
 Peripheral chemoreceptors in the aorta
and external carotid arteries sense PO2,
PCO2 and pH of arterial blood
Co ntr ol o f Ve ntila tion

 Respiratory control center in the medulla

controls the pattern of respiration
 Voluntary respiration originating in the
motor cortex bypasses the medulla,
impulses travel down the corticospinal
directly to respiratory muscles
 In breath-holding, voluntary control
initially predominates, then the RCC
overpowers it
Br eakin g Po int

 Duration that a person could hold his/her

breath
 Related more to the partial pressure of
CO2 than to O2
Lung Ca pacit y

 Total lung capacity (TLC) = 6 L. The volume of gas contained in the lung at the end of maximal inspiration.
 Vital capacity (VC) = 4.8 L. The amount of air that can be forced out of the lungs after a maximal inspiration.
 Tidal volume (TV) = 500 mL. The amount of air breathed in or out during normal respiration.
 Residual volume (RV) = 1.2 L. The amount of air left in the lungs after a maximal exhalation.
 Expiratory reserve volume (ERV) = 1.2 L. The amount of additional air that can be breathed out after normal
expiration. (At the end of a normal breath, the lungs contain the residual volume plus the expiratory reserve
volume, or around 2.4 liters. If one then goes on and exhales as much as possible, only the residual volume of
1.2 liters remains).
 Inspiratory reserve volume (IRV) = 3.6 L. The additional air that can be inhaled after a normal tidal breath in.
 Functional residual capacity (ERV + RV) = 2.4 L. The amount of air left in the lungs after a tidal breath out.
 Inspiratory capacity (IC) = is the volume that can be inhaled after a tidal breathe-out.
No rmal Insp iration

 Respiration involves the tidal volume of

air
 Around 2.9L of air in the lungs
De ep expira tio n

 Vital capacity is expelled

 Only residual volume of air is left, around
1.2L
 Low oxygen in tissues, CO2 is also
accumulating
 Shortest breaking point
De ep Br eathing

 Tidal volume and IRV are utilized in

breaths
 Larger amount of air enters the lungs
(around 3.6L per breath)
 Longest breaking point due to larger O2
concentration in blood
Ba g Br eathing

 Shorter breaking point than normal deep

breathing
 Re-breathing increases the CO2
concentration in the blood while also
lowering the amount of inspired oxygen
• Low levels of oxygen and/or high levels of
carbon dioxide in the body stimulates
resumption of breathing and faster,
deeper breathing
• Arterial CO2 is the most important
regulator of ventilation
• PaO2 levels below 60 mm Hg and PaCO2
levels above 40 mm Hg trigger increased
respiration
Co nclusion
 There is generally an increase in chest circumference
during inspiration and a decrease in circumference
during expiration.
 Greatest increase was during forced inspiration
 Greatest decrease was during forced expiration

 The fastest breaking point is influenced by the

concentration of O2 and CO2 in the body
 Shortest breaking point is after forced expiration
 Longest breaking point is after forced inspiration
EXP ER IME NT NO .
25
Examination of the Chest and Lungs
OBJECTIVE
To demonstrate the different
methods and proper techniques of
chest examination useful in the
assessment of respiratory function.
MET HOD OL OGY

 Inspection
male subject was made to sit upright
↓
configuration and symmetry of the chest on
inspiration observed
↓
configuration and symmetry of the chest on
expiration observed
MET HOD OL OGY

↓
rate, depth and pattern of respiration also
observed
↓
presence of abnormal sounds when
breathing, retractions, use of accessory
muscles and increased anterior-posterior
diameter or barrel chest noted if present
MET HOD OL OGY
 Palpation

each of the examiner’s thumbs of the hand was

placed to the side of the spinal processes in
the mid-thoracic region
↓
fingertips were extended to the mid-axillary line
on both sides
↓
subjects were asked to inhale deeply
↓
degree and symmetry of chest expansion
evaluated
MET HOD OL OGY
Fremitus
examiner’s hand was
placed on the
subjects’ back
↓
vibration on the chest
noted by asking the
subjects to say
“ninety-nine” or “tres-
tres”
MET HOD OL OGY
 Percussion
chest was percussed with
the distal parts of the
middle and index fingers
of one hand pressed
firmly against the chest
wall and the middle
finger of the other hand
used to strike sharply the
fingers on the chest wall
↓
MET HOD OL OGY
character of percussion on both sides of the chest, from
top to bottom, anteriorly and posteriorly was noted
↓
subject inhaled
↓
steps 1 then character of percussion noted
↓
subject exhaled
↓
steps 1 then character of percussion noted
MET HOD OL OGY
 Auscultation
Using the stethoscope, the lungs was auscultated

over the
apices of both
lungs then
down back
↓
MET HOD OL OGY

in the
axillae
↓
anteriorly on
both sides
RES UL TS AN D
DI SCU SSI ON
 Inspection
Degree of Symmetry of Fremitus
Expansion Expansion

Male Subject Within Symmetrical Normal and

normal equal on both
sides

Female Subject Within Symmetrical Normal and

normal equal on both
sides
RES UL TS AN D
DI SCU SSI ON
 Palpation
Degree of Symmetry of Fremitus
Expansion Expansion

Male Subject Within Symmetrical Normal and

normal equal on
both sides
Female Subject Within Symmetrical Normal and
normal equal on
both sides
RES UL TS AN D
DI SCU SSI ON
 Percussion

The base of the lung was located on the

subjects by identifying flatness which
indicates that the tissue beneath is a
muscle, the diaphragm next to resonance
indicating that the tissue beneath is
hollow, the lungs
↓
RES UL TS AN D
DI SCU SSI ON
Inferior angle of the scapula was used as the
reference point in measuring the boundaries of
resonance

Distance from inferior angle of scapula

Inspiration decreased

Expiration increased
RES UL TS AN D
DI SCU SSI ON
 Auscultation

Normal breath sounds were appreciated on

both subjects upon auscultation.

The normal breath sounds are:

Br onchove sic ula r

 Mixture of both
tracheobronchial and
vesicular elements in
certain areas where
the trachea and
major bronchi are in
close proximity to the
chest wall
Ve sic ula r

 Result of movement
of air in the
bronchioles and
alveoli
Ve sic ula r vs
Br onchove sic ula r
Sound Duration of Pitch Intensity Normal Abnormal
inspiration Location Location
and
expiration

Vesicular Inspiration > Low Soft Peripheral Over trachea

expiration lung and
5:2 sternum

Broncho- Inspiration = Moderate Moderate First and Peripheral lung

vesicular expiration second
1:1 intercostal
spaces at
the border
over major
bronchi
CON CL US ION
There are 4 general steps in chest
and lung examination:
INSPECTION
PALPATION

PERCUSSION

AUSCULTATION
ANS WER S to
QU ESTI ONS
1. Give the different percussion sounds and the
palpable vibrations arising from the
respiratory tree.

PERCUSSION SOUNDS:
 Resonance

Hyperresonance

Tympany
 Dullness
 Flatness
ANS WER S to
QU ESTI ONS
Sounds Relative Relative Pitch Relative
Intensity Duration
Resonance Loud Low Long
Hyperresonance Very Loud Lower Longer
Tympany Loud
Dullness Medium Medium Medium
Flatness Soft High Short

Table 1. Percussion notes and their Characteristics (Bates,1983)

ANS WER S to
QU ESTI ONS
VIBRATIONS during PALPATION:
 Vocal Fremitus
 Pleural Friction Fremitus

Tussive Fremitus

Ronchal Fremitus
ANS WER S to
QU ESTI ONS
2. Give the 2 normal breath sounds. Where are these
sounds heard best?

 Vesicular Breath Sounds-

heard normally over most of the lungs


Bronchiovesicular Breath Sounds-
heard normally on each side of the sternum in the
first and second interspaces, between the scapulae,
and over the apices anteriorly and posteriorly, but is
more prominent on the right than on the left
Exp er ime nt no .
26
Lung Volumes and Capacities
Ob je ctive :

 To be able to measure the different lung

volumes and lung capacitites using wet
spirometer.
Ma teria ls

 Wet spirometer
Me thodolo gy

 Tidal volume

2. Set the spirometer at 0 mL.

3. At the end of a normal inspiration, exhale
normally into the spirometer.
4. Record the reading obtained.
5. Make 3 trials and get the average.
Me thodolo gy

 Expiratory Reserve Volume (ERV)

1. Set the spirometer at 0 mL.

2. After normal exhalation, exhale forcibly into
the spirometer.
3. Record the reading obtained.
4. Make 3 trials and get the average.
Me thodolo gy

 Inspiratory Reserve Volume (IRV)

2. Set the spirometer at 0 mL.

3. After deep inspiration, exhale forcibly into
the spirometer.
4. Record the volume obtained.
5. Subtract tidal volume from this volume to
obtain IRV.
6. Make 3 trials and get the average.
Me thodolo gy

 Vital Capacity

1. Set the spirometer 0 mL.

2. After deep inhalation, exhale forcibly into
the spirometer.
3. Record the reading obtained.
4. Make 3 trials and get the average.
Me thodolo gy

 Inspiratory Capacity (IC)

1. Set the spirometer at 0 mL.

2. After normal expiration, inhale deeply into
the spirometer.
3. Record the reading obtained.
4. Make 3 trials and get the average.
Re su lt s
Lung volume and Male Female
Capacities Subject Subject
(standing) (sitting)
(L) (L)
Tidal Volume 0.53 0.45

Expiratory 1.30 1.10

Reserved Volume
Inspiratory RV 2.83 1.92

Vital capacity 4.13 2.70

Inspiratory capacity 3.93 2.47

Disc ussio n
Lung Vo lume s a nd
Ca pacitie s
Lung VO LUMES
 Tidal Volume (TV or VT)
 volume of air moved during either the inspiratory or expiratory phase of
each breath; as in quiet breathing
 Inspiratory Reserve Volume (IRV)
 volume of air which can be inspired above the inspired tidal volume
 value decreases with increasing age.
 Expiratory Reserve Volume (ERV)
 volume of air which can be expired beyond the expired tidal volume
 effort-dependent
 values decreases with increases in age.
 Residual Volume (RV)
 The volume of air in lungs after maximum exhalation
 Cannot be exhaled and remains in lung so as lung structures; lungs are
never devoid of air
 Tends to increase with age
 Cannot be measured directly; indirectly via the helium dilution method
Th eoretic al Va lu es
Lung volume and Theoretix Theoretical-
Capacities male Female
(standing) (standing)
(L) (L)
Tidal Volume 0.45-0.55 0.35-0.50

Expiratory 1.0-1.5 0.9-1.2

Reserved Volume
Inspiratory RV 2.5-3.5 1.9-30

Vital capacity 4-5 3–4

Inspiratory capacity 3-4 2.4-3.2

Lung CA PACI TI ES

IRV
IC
Can Use
VC
Spirometer
TLC TV

ERV
FRC

RV RV
VI TAL CA PACI TY
 Vital Capacity (VC)
 The amount of air that can be moved into/out of your lungs
 maximum volume of air that can be forcefully expelled from the
lungs following a maximal inspiration
 Largest volume that can be measured with a spirometer
 VC = IRV + TV + ERV
 Values vary considerably with body size and body positions
during the measurement.
 is related to age, height, and gender
 The younger and taller one is the larger the VC
 Men have larger lungs than women which enable men to exhibit
greater VC
 Average values:
 4 - 5 liters in men
 3 - 4 liters in young women.
TO TAL L UN G
CAP ACI TY
 Total Lung Capacity
 The volume of air contained in the lungs at
the end of a maximal inspiration.
 Sum of all four basic lung volumes
 TLC = RV + IRV + TV + ERV
Functional Re sid ual
CAP ACI TY
 Functional Residual Capacity
 The volume of air remaining in the lung at the
end of a normal expiration.
 FRC = RV + ERV
INSPI RATOR Y
CAP ACI TY
 Inspiratory Capacity (IC)
 Maximum volume of air that can be inspired
from end expiratory position.
 IC = TV + IRV
On Clo se r
Ex amin ation…
Lung volume and Theoretix Male Theoretical- Female
Capacities male Subject Female Subject
(standing) (standing) (standing) (sitting)
(L) (L) (L) (L)
Tidal Volume 0.45-0.55 0.53 0.35-0.50 0.45

Expiratory 1.0-1.5 1.30 0.9-1.2 1.10

Reserved Volume
Inspiratory RV 2.5-3.5 2.83 1.9-30 1.92

Vital capacity 4-5 4.13 3–4 2.70

Inspiratory 3-4 3.93 2.4-3.2 2.47

capacity
De via tio ns…
 All values except VC (female) are normal
 Vital Capacity (IC)
 For the female subject, the procedures
were done in sitting position
 All values are observed to be on the
lower limit of the range
 Vital capacity is affected by body size and
body positions during the measurement
Lung Vol ume Capaci ti es
in Mal e an d Fem ale
 Males of a given body size have an
approximately 25% greater pulmonary volumes
and capacities than females of equal size (2.5
l/m2 of body surface area vs. 2.0 l/m2)

 Difference is observed even with exclusion of

height variable: lung growth is not very tightly
coupled to longitudinal growth
Smal ler lung vol ume
capaci ti es in femal es…
 appears to be established in the first few years of life
 lower rate of alveolar multiplication in girls than boys
 females have disproportionately smaller rib cage
dimensions than males.
 greater inclination of ribs
 stronger inspiratory rib cage muscle contribution in females
than males
 improved mechanical advantage conferred to the inspiratory
rib cage muscles
 well suited to accommodate abdominal distension during
pregnancy
 compression of the rib cage by the weight of the breast
 shorter diaphragm length
 smaller lung compliance and lung size in female

(Bellemare, et al. (2003)

Lung Vol ume and
Capaci ti es in di ff erent
body posi
Lung volume and
ti ons
Theoretical- Female
Capacities Female Subject
(standing) (sitting)
(L) (L)
Tidal Volume 0.35-0.50 0.45

Expiratory 0.9-1.2 1.10

Reserved Volume
Inspiratory RV 1.9-30 1.92

Vital capacity 3–4 2.70

Inspiratory capacity 2.4-3.2 2.47

Lung Vol ume and
Capaci ti es in di ff erent
body posi ti ons
 Standing position
Lung Vol ume and
Capaci ti es in di ff erent
body posi ti ons
 Sitting position
Lung Vol ume and
Capaci ti es in di ff erent
body posi ti ons
 Supine position
CON CL USI ON
A wet spirometer is an important apparatus
in measuring the lung volumes and capacities of
an individual. It can be considered as an
important diagnostic tool in determining
obstructions in the lungs/airways. There is a
comparable difference of the lung volumes and
capacities between a male and a female subject.
Usually, males have greater lung volumes and
capacities due to their larger built, and taller
height.
An wers to Qu est ions:
1. The measurement of the different lung volumes and capacities
should be done with the subject standing. Why?

Standing enables the chest wall to move freely. The lungs are
enclosed by the chest wall which expands during inspiration.

Chest wall is a term commonly used to describe the properties

of all the structures that are outside of the lungs and that move
during breathing. These structures include the rib cage,
diaphragm, abdominal cavity, and anterior abdominal muscles.
(Berne, 2004). When the subject is standing, there is no
compression from the abdominal cavity therefore, it allows full
expansion of the chest wall.

When the subject is sitting, the digestive organs in the

abdominal cavity compresses the diaphragm therefore limits
lengthening of respiratory muscle and lung expansion.
An wers to Qu est ions:

2. Compare the lung volumes of male and

female subjects. Show tabulated results
here.

Comparing the average of the lung

volumes obtained from the female and male
subject, we can see that the male subject has
greater volumes. The results obtained are
tabulated.
Tab le 1. Lung v olum es
obtai ned fr om femal e
subj ect.
FEMALE SUBJECT Trial 1 Trial 2 Trial 3 Average
(mL) (mL) (mL) (mL)
Tidal volume 450 500 400 450

Expiratory Reserve 1400 900 1000 1100

volume (ERV)
Inspiratory Reserve 2300- 2400- 2400- 1916.67
Volume (IRV) 450 500 400
= 1850 = 1900 = 2000

Vital Capacity 2700 2700 2700 2700

Inspiratory Capacity 2400 2800 2200 2466.67

(IC)
Tab le 2. Lung v olum es
obtai ned fr om mal e
subj ect.
MALE SUBJECT Trial 1 Trial 2 Trial 3 Average
(mL) (mL) (mL) (mL)
Tidal volume 550 500 550 533.33

Expiratory Reserve 1000 1600 1300 1300

volume (ERV)
Inspiratory Reserve 3500- 3400- 3200-550 2833.33
Volume (IRV) 550 500 = 2650
= 2950 = 2900

Vital Capacity 4200 4000 4200 4133.33

Inspiratory Capacity 4000 4000 3800 3933.33

(IC)
 When individuals are matched for height and
weight, males normally have larger lungs than females.
Height is the most important factor influencing lung size
and predicted values. Generally, the taller the person, the
larger the lung size and predicted lung volumes.

If a person gains weight by putting on muscle, a

“muscularity effect” is seen by an increase in lung size.
As the weight gain continues because of an increase
body fat, there is reduction in lung size, which if allowed
to continue, results in the obesity effect and reduced lung
volumes. (Wilkins, 1995)
An wers to Qu est ions:
3. Define:
a. Tidal volume

It is the volume of air exhaled or inhaled during quiet

breathing. The average values for healthy adults show
considerable variation but usually fall between 350 and
600 mL. (Wilkins, 1995)

A decreased VT can occur with both restrictive and

obstructive disease. A fall in VT without an increase in
rate may result in hypoventilation and retention of
arterial carbon dioxide tension. Restrictive lung disease
usually causes the patient to breath with a smaller VT.
a. Expiratory Reserve Volume

It is the volume of air that can be maximally exhaled

following a passive exhalation. This volume is of limited
clinical usefulness. It is reduced in obese persons, in those
making a poor effort to perform the test, and in those with
restrictive disease. Normal value: 1,100 to 1,200 mL

c. Inspiratory Reserve Volume

It is the volume of air that can be inhaled after a

passive inhalation. This is not widely used in evaluating
pulmonary dysfunction. Normal value: 3,000 to 3,200 mL.
a. Vital Capacity

It is measured after the person has taken the

deepest breath possible. The exhaled volume should
be the maximal amount the patient can exhale and
is measured as the vital capacity. If the patient
forcefully exhales the volume, it is called the forced
vital capacity (FVC) and is the usual way the VC is
reported.

VC is also reported as slow vital capacity (SVC).

It is performed by having the patient completely
exhale, slowly, following a maximal inspiration.
 VC is an important preoperative assessment factor.
Significant reduction in VC (less than 20 mL/ Kg of ideal
body weight) indicates that a patient is at high risk for post
operative respiratory complications. It is also useful in
evaluating the patient’s need for mechanical ventilation. A
VC of less than 10 to 15 mL/ Kg indicates that the
patient’s ventilatory reserve is decreased significantly.
a. Inspiratory Capacity

It is the total volume of air in the lungs

during inspiration. This includes the volume of
air during normal inhalation and the volume of
air after deep inspiration. Normally ranges from
3,500 to 3,600 mL. IRV and IC are not used
widely in evaluating pulmonary dysfunction.
Both of these measurements can be normal in
restrictive and obstructive diseases.
An wers to Qu est ions:

1. What lung volume was not measured in this

exercise? Why not?

The residual volume was not measured. RV is the

amount of gas left in the lung after exhaling all that is
physically possible. It cannot be obtained from the
routine spirogram. It is obtained however in one of
the three ways:
(a.) body plethysmograph (body box), (b.) open
circuit nitrogen, or (c.) closed circuit helium dilution.
Ex perimen t No. 27

Peak Expiratory Flow

Rate (PEFR)
Ob je ctive s

 To determine the peak expiratory flow

rate using the peak flow meter.
Ma teria l

 Mini-Wright peak flow meter

Pr ocedure

 The subject while standing, was asked to

take a deep breath and blow as hard and
as fast as he can into the mouthpiece of
the peak flow meter
 Values obtained were recorded and
tabulated.
 The test was repeated twice more to get
the average.
 Get the subjects
height and plot the
highest value of
PEFR in the peak
flow rate nomogram.
Re su lt s
Expected
Subject Age Ht. in cm Trial 1 Trial 2 Trial 3 Ave.
Value

Divine 22 157 440 420 440 433 410

LPM

Pat 21 183 550 500 530 526 545

LPM
Re su lt
600
500
400
Divine
300
Pat
200
100
0
e
t
ul

lu
es

Va
R

ed
ct
pe
Ex
Disc ussio n

 High or Low Reading is dependent on

the subject’s sex, height, age and
severity of disease.
 The male subject obtained higher PEFR
than the female.
 High peak flow reading means air is
moving easily through the lungs.
Co nclusion

The peak expiratory flow rate of

subjects A & B were obtained following the
proper procedures. In comparison with the
standard values with respect to each of the
subject’s height, both have a normal peak
expiratory flow rate.
Qu estio ns a nd Answe rs

1. What is measured by the peak flow meter?

 Peak flow meter measures the Peak

Expiratory Flow Rate, which is the highest
speed that you can blow air out of the lungs
after taking in as big a breath as possible.

 It indicates the airflow speed in liters per

minute.
Quest ions and Answe rs

1. Give some uses of peak flow meter.

 To detect changes in your peak flow

which will tell you what is happening w/
your lungs, how quickly it is occurring,
and how severe the change is.
 Useful in determination of treatment
plan.
Quest ions and Answe rs

1. What is the significance of the peak

expiratory flow rate?

 It is important in monitoring and

diagnosing lung diseases.
 It measures how well the airways of a
person works.
 It is helpful in distinguishing between
constrictive (TB, silicosis) and obstructive
(asthma) lung disease. In asymptomatic
cases, it may be the only means of
diagnosis.
 It can point out specific trigger factors for
asthma and can help judge the response
to medication.