Pulmonary Function Testing

Application: Pulmonary Function Testing
Patients with respiratory disorders often require short-term and long-term treatment.
While short-term treatments may successfully relieve a patient’s current symptoms, long-
term treatment and management is a necessary component of the care plan. Prior to
establishing a care plan, it is essential to complete a thorough patient evaluation. Patients
presenting with symptoms of respiratory disorders such as chronic obstructive pulmonary
disease (COPD) frequently require pulmonary function testing. These pulmonary function
tests are designed to assess patient lung function. Results of these tests can be used in
conjunction with the COPD guidelines to develop effective treatment and management
plans for patients.
To prepare:
Review the COPD guidelines in the Global Initiative for Chronic Obstructive Lung Disease
article
Reflect on COPD diagnosis, management, and prevention strategies suggested in the
guidelines. Consider how to implement these strategies in a clinical setting.
Locate and select a case study from a reputable source on a patient whose condition
required pulmonary function testing.
Consider the COPD guidelines for diagnosis and think about a potential diagnosis for the
patient in the case study that you selected.
Reflect on treatment and management options based on the patient’s diagnosis.
To complete:
Write a 3- to 4-page paper that addresses the following:
Describe COPD diagnosis, management, and prevention strategies suggested in the COPD
guidelines. Explain how to implement these strategies in a clinical setting.
Explain your diagnosis for the patient in the case study that you selected. Compare the
patient’s pulmonary function test results to the COPD guidelines when making your
diagnosis.
Describe treatment and management options based on the patient’s diagnosis

Pulmonary Function Testing

COPD stands for Chronic Obstructive Pulmonary Disease and is a treatable disease
characterized by airflow obstruction that is normally progressive and is associated with an
abnormal inflammatory of the lungs to noxious particles or gases. COPD is a collective name for
a variety of progressively lung diseases like emphysema and chronic bronchitis (Sharma, 2009).
Symptoms of this disease include dyspnea, chronic cough, or sputum.

PULMONARY FUNCTION TESTING 2
Diagnosis should be done on patients who exhibit the above symptoms or who have been
a history to exposure to risk factors like tobacco smoke, or industrial air pollution. This disease
has several stages. Stage one known as mild COPD is characterized by mild airflow limitation.
In this stage, the patient is normally unaware that he is suffering from COPD as most times the
symptoms of chronic cough or sputum production may not be present. Stage two is known as
moderate COPD and is characterized by worsening airflow limitation and includes shortness of
breath, chronic coughing and sputum production. Patients normally seek medical attention at this
stage due to the severity of the symptoms. Stage three is known as severe COPD is characterized
by the worsening of the airflow limitations, more severe shortness of breath, fatigue and
increased symptoms that make one’s life uncomfortable. Stage four is Very Severe COPD which
is characterized by severe airflow limitation and respiratory failure (GOLD, 2006).
Spirometry is a required to make a diagnosis in a clinical setting. It consists of a simple
test to measure the amount of air a patient can breathe out and the amount of time taken to do
that. It is done by using a spirometer which is like a gasmask. Measurements gotten from a
spirometer include the FVC or forced vital capacity which is the maximum volume of air that
can be exhaled. Next is the FEV or forced expired volume which is a measure of how quickly the
lungs can be emptied. A value of less than 0.7 FEV/FVC indicates the presence of OCPD.
Healthy people have FEV/FVC measurements of between 0.7 and 0.8 (GOLD, 2006).
Once COPD has been diagnosed, assessment follows which is a process of determining
the severity of the disease and its impact on the patient. Assessment is done by examining each
condition of the disease. The first condition is the symptoms – these are further analysed using
the breathlessness scale of questionnaires like the COPD assessment Test (CAT) or the
Modified Medical Britsh Research Council (mMRC). Next is the assessment of the degree of

PULMONARY FUNCTION TESTING 3
airflow limitation. A patient can be found to have either mild, moderate, severe or very severe
COPD after a spirometer test. The risk of exacerbations is assessed after this which is a test that
examines whether the symptoms of the disease are worsening. Lastly, we assess comorbidities
which involves the checking of presence of other diseases like lung cancer, skeletal muscle
dysfunction, depression and such others. These if left unchecked can lead to hopitalisation or
mortality (Sharma, 2009).
Management should take place based on assessment of current symptoms and future
risks. The goal is to relief symptoms and also to prevent disease progression. Treatment is of two
ways, pharmacologic treatment, and non-pharmacologic treatment. Pharmacological treatment is
used in mild COPD (stage 1 & 2) to control symptoms & avoid disease progression. Severe
OCPD requires various treatment methods including non-pharmacologic treatment like exercise
training, nutrition training and education on the disease (Wouters, 2003).

A patient who needs pulmonary function testing undergoes the spirometry test. This test
measures how much and how quickly you can move air out of your lungs. It consists of a patient
breathing into a mouthpiece attached to a recording device or spirometer. The information
collected by the spirometer may be printed out on a chart called a spirogram. Before taking the
test, the patient is advised not to eat a heavy meal before the test and not to smoke for 4 – 6 hours
before the test. This test is performed for various reasons. One is to diagnose certain types of
lung diseases. Second is to find the cause of shortness of breath. Third is to measure whether
exposure to chemicals at work affects lung function. Lastly to check for lung function before
someone goes for surgery. It can also be done to assess the effect of medication or to measure
progress in disease treatment.

PULMONARY FUNCTION TESTING 4
Results are evaluated by comparison of the results with appropriate reference values
based on age, height, sex, and race. Results include the FVC or forced vital capacity which is the
maximum volume of air that can be exhaled or the FEV or forced expired volume which is a
measure of how quickly the lungs can be emptied. A value of less than 0.7 FEV/FVC indicates
the presence of OCPD. Healthy people have FEV/FVC measurements of between 0.7 and 0.8.

The patient can thus be diagnosed to having any of the four stages of OCPD i.e. mild,
moderate, severe or very severe OCPD. Mild OCPD occurs when the FEV values are less than
80%. Moderate occurs when the FEV values are between 50-80% while severe occurs when the
FEV values are between 30-50%. Very severe OCPD occurs when the FEV values are below
30% (GOLD, 2006). This patient has been diagnosed with stage one OCPD and therefore the
treatment would be the taking of bronchodilator i.e. a medicine that increases the FEV or makes
the muscle tone I the airway smooth. It can be taken in form of an inhaler. Also non
pharmacological treatment can be given in the form of education i.e. enlighten the patient on
what is OCPD and how to take care of themselves (Eisner et al, 2006).

References

Eisner, D., Balmes, J., Katz, B., Trupin, L., Yelin, E., Blanc, P. (2005). Lifetime environmental
tobacco smoke exposure and the risk of chronic obstructive pulmonary disease. Environ
Health Perspect; 4:7-15.
GOLD. (2006). Guidelines for the Global strategy for the diagnosis, management, and
Prevention of chronic obstructive pulmonary disease. Retrieved from www.goldcopd.org

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Sharma, D. (2009). Pulmonary function testing in neuromuscular disorders. Journal of
Pediatrics. 123 Suppl 4: S219–21
Wouters, F. (2003). The burden of COPD in The Netherlands: results from the Confronting
COPD survey. Respiratory Med;97 Suppl C:S51-9.

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