The investigation of ventilatory function is part of the usual paraclinical examination in diseases of the respiratory system and in diseases of other devices and systems with an impact on ventilation. In occupational medicine, spirometry is a mandatory functional exploration of subjects exposed to irritants, allergens or powders.
This book is a collaboration between a pulmonologist with applied research interests, a professor dedicated to training specialists in the diagnosis and treatment of occupational diseases and an occupational physician passionate about physiology and pathophysiology. It was conceived as a translation of theoretical concepts in everyday medical practice, because the notions of functional anatomy and ventilation physiology represent the basis for understanding the changes that characterize obstructive or restrictive dysfunctions.
MARINA OTELEA - Coordonator
FAYSSAL EL HUSSEINI
Chapter 1. Anatomy of the respiratory system - Agripina Rascu / 11
1.1. Introduction. Definitions / 11
1.2. Airways / 12
1.3. Chest / 13
1.4. Lungs / 13
1.5. Vascularization of the respiratory system / 15
1.6. Alveolo-capillary barrier / 16
Chapter 2. Notions of ventilation physiology - Marina Otelea / 19
2.1. Introduction. Definitions / 19
2.2. Respiratory cycle / 22
Chapter 3. Spirometry - Fayssal El Husseini, Marina Otelea, Agripina Rascu / 27
3.1. Introduction. General notions / 27
3.2. Indications and contraindications / 29
3.3. Conditions for performing spirometry / 32
3.4. How to work / 32
3.4.1. Exam preparation / 33
3.4.2. The actual making of the registration / 33
3.4.3. Sources of registration error / 34
3.4.4. Displaying results. Reference values / 35
3.5. Characteristics of the volume flow curve (loop) / 38
3.5.1. Criteria for validating the flow-volume curve / 38
3.6 Characteristics of the volume-time curve / 44
3.6.1 Validation criteria of the volume flow curve / 45
3.7 Functional parameters measured using spirometry / 46
3.8 Interpretation of spirometry / 48
Chapter 4. Restrictive dysfunctions - Agripina Rascu / 55
4. 1. The pathophysiological substrate of restrictive dysfunctions / 55
4.1.1. Introductory notions / 55
4.1.2. Pathophysiological classification of restrictive dysfunctions / 56
4.1.3. Intrinsic restrictive pathologies (pulmonary) / 57
4.1.4. Extrinsic restrictive pathologies / 62
4.1.5. Respiration at small lung volumes / 66
4.2. Volume flow loop in restrictive dysfunctions / 67
4.3. Complementary functional explorations in the diagnosis of restrictive dysfunction / 69
4.3.1. Determination of CPT, CRF and VR / 69
4.3.2. The diffusion capacity of CO in restrictive dysfunctions / 71
4.3.3. Evaluation of respiratory muscle strength / 74
4.4. Diagnostic criteria and severity in restrictive dysfunctions / 75
Chapter 5. Obstructive dysfunctions - Marina Otelea / 78
5. 1. The pathophysiological substrate of obstructive dysfunctions / 78
5.1.1. Introductory notions / 78
5.1.2. Pathophysiological classification of obstructive dysfunctions / 81
5.1.3. Pulmonary obstructive pathologies / 81
5.1.4. Extrathoracic obstructive pathologies / 91
5.1.5. Obstructive dysfunction of the large intrathoracic airways / 91
5.2. Volume flow loop in obstructive diseases / 91
5.3. Complementary functional explorations in the diagnosis of obstructive dysfunction / 94
5.3.1. Determination of CPT, CRF and VR / 95
5.3.2. Determination of Raw and Gaw / 97
5.3.3. The diffusion capacity of CO in obstructive dysfunctions / 98
5.3.4. Functional exploration of the distal airways / 99
5.4. Diagnostic criteria and severity in obstructive dysfunctions / 101
Chapter 6. Modification of respiratory functional tests in the main occupational lung diseases Fayssal El Husseini, Marina Otelea, Agripina Rascu / 107
6.1. Introduction / 107
6.2. Respiratory dysfunctions in the main types of occupational lung diseases / 108
6.2.1. Respiratory functional changes in silicosis / 108
6.2.2. Respiratory functional changes in asbestosis / 109
6.2.3. Respiratory functional changes in extrinsic allergic alveolitis / 110
6.2.4. Respiratory functional changes in occupational asthma / 110
6.3. Practical applications / 112
Respiratory functional exploration is an essential component of the diagnosis in many pathologies and spirometry is, in most cases, the first stage of this journey.
In occupational pathology, spirometry is the paraclinical investigation of monitoring exposure to occupational lung disease, whether it is pneumoconiosis, asthma, extrinsic allergic alveolitis, chronic obstructive pulmonary disease, to name just the most common. It is also a necessary examination, even if not alone, to assess a possible reduction in the capacity for effort and adaptation to overload.
Spirometry is an investigation that can be performed by any doctor in outpatient conditions if he respects the technique and precautions. Therefore, we wanted to write a book that can serve as information for a more nuanced interpretation of the results and for understanding the indications for requesting additional examinations, in specialized services.
I want to thank my colleagues who enthusiastically responded to the invitation to work on this book, Prof. Dr. Agripina Rascu and Dr. Fayssal El Husseini, doctors with distinguished concerns in the field of functional respiratory exploration, in Romania and France, respectively.
The dialogue with them is an example of a transition from my current concerns, aimed at identifying functional and pathophysiological mechanisms, to clinical medicine, in which both work and in which they have a rich experience. In fact, the applied research laboratory that Dr. Fayssal El Husseini leads in Paris is in itself a working model of a comprehensive functional exploration in various respiratory pathologies.
I cannot conclude without a thought of thanks to the two masters who, many years ago, opened the door to the fascinating world of functional respiratory exploration: Dr. Stefan Dutu, the passionate leader of the Laboratory of Respiratory Physiology and Pathophysiology in The “Marius Nasta” Institute and Dr. Nicolae Muica, an excellent connoisseur of occupational respiratory pathology, with whom we interpret the functional explorations of the patients hospitalized in the Clinic of Occupational Diseases from Colentina Hospital during my residency.
I hope that through this book what I have learned from them and what I have completed through reading and practical experience will reach the students and doctors who will go through these pages.