Question

James Fishel is a 56-year-old maintenance worker who has worked for the same company for 32 years, spending most of his time installing and removing insulation from buildings. He saw his physician with complaints of becoming increasingly short of breath over the past year, particularly when he is exerting himself. He notes that "just getting enough air in" is exhausting. A chest X-ray revealed a "shaggy" (i.e. blurred) heart border and a hazy appearance of the lungs. Pulmonary function testing was done and the results are shown below.   (Note this graph is a spirogram with volume over time. Pt. begins with tidal breathing than takes a maximal inhalation followed by a maximal exhalation as rapidly as possible, and then returns to tidal breathing).

A. Based on the graph, calculate the following: FVC, FEV1, FEV1/FVC ratio, TLC, RV, and RV/TLC ratio.   Given the patient’s FEV1/FVC ratio and RV/TLC ratio, explain if this patient’s disorder is obstructive or restrictive.

B. What specifically do you think caused his lung disease?

7000 Pulmonary Function Testing 3000

Answer 1

Answer A
FEV1 / FVC ratio = 2500 cc / 2700 cc or 0.93
Although a FEV1 / FVC ratio greater than 0.80 is found in individuals with normal lung function, it may indicate restrictive lung disease when it occurs in combination with a below-normal FVC such as James. In restrictive lung disease, the patient has difficulty expanding the lungs. In other words, pulmonary complacency is diminished below normal. This causes the volume of respiratory reserve and the total lung capacity of James to be less than normal. However, it does not reduce the maximum rate at which air can be exhaled and therefore does not decrease the FEV 1 / FVC ratio.

AnswerB
Since James worked for 32 years in removing insulation from buildings, it is more
He is likely to suffer from lung asbestosis, a condition caused by excessive inhalation of asbestos, used in older forms of insulation. The inhaled asbestos filaments reach the lungs where they irrigate the lining of the small airways and alveoli. The body summons the response of the macrophages, trying to digest and remove the asbestos particles. The inflammatory response that occurs in healing diffuse formation of scar tissue makes lung tissue hard and difficult to expand - a condition called pulmonary fibrosis.