pulmonary function test interpretation pdf

Office-based pulmonary function testing, also known as spirometry, is a powerful tool for primary care physicians to diagnose and manage respiratory problems. Spirometric measurements like the forced expiratory volume in 1 second inform about the degree of airflow obstruction, whereas the flow-volume loop helps identify the presence and anatomic location of upper airway obstruction, which may mimic symptoms of obstructive lung disease. Sound waves are superimposed on, normal tidal breathing and the disturbances in flow, and pressure caused by the external waves are used to, calculate parameters describing the resistance to airow, and reactive parameters relating to ecient storage and, return of energy by the lung. Previous studies have shown that the added resistance of a mini-Wright peak expiratory flow (PEF) meter reduced PEF by approximately 8% in normal subjects because of gas compression reducing thoracic gas volume at PEF and thus driving elastic recoil pressure. H�b```f``��w�A��b�,��$0�a��p�{��@mg*�v,�\�v2��a ! Two strategies have been devised. 0000050913 00000 n 0000015700 00000 n Examples, that the obstruction is present either during inspiration, or expiration unlike a xed obstruction which is present, in both phases. most commonly used ones in daily practice are: e basic PFT is essentially done by two methods: spirometer with a disposable mouth piece. 0000019211 00000 n Free Medical Book PDF: Interpretation of Pulmonary Function Tests 4th Edition PDF. T��K��0?��Gu�5 p�"9�@�l%d ��2=�.�-��9�v��e�{w��8�.S��2�_�� Y�G�2�0�H��4� New data suggest that IOS may be useful in predicting loss of asthma control in the pediatric population. We asked 26 pulmonary physicians to interpret results of ten consecutive pulmonary function tests from one laboratory. Pulmonary Function Testing What do pulmonary function tests tell you? 0000012029 00000 n 0000023377 00000 n 2. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders. Join ResearchGate to find the people and research you need to help your work. 0000020002 00000 n Introduction. Characteristics of an ideal flow-volume curve. H�tS�r�0��Io��:��9t��# ;��w%�!��c��оݷ��ζfq�d�� Ғ��K��h��V�؞I��;F�(Y�n�. predicted and percentile values for pulmonary function test interpretation. These differences may be partially due to differences in body build: observed Mexican-Americans were shorter than Caucasian subjects of the same age, and African-Americans on average have a smaller trunk:leg ratio than do Caucasians. Two cases of vocal cord disorders were presented with dyspnea and initially attributed to pulmonary causes and will be discussed in the present study. Combined obstruction and restriction occurs infrequently and is more commonly caused by a combination of pulmonary parenchymal and non-pulmonary disorders. 0000008365 00000 n Impulse oscillometry (IOS), a simple, noninvasive method using the forced oscillation technique, requires minimal patient cooperation and is suitable for use in both children and adults. The two most important dynamic lung volumes measured are the forced vital capacity (FVC) and the forced expiratory volume in the, The frequency of combined obstruction and restriction identified in pulmonary function tests has not been well described. Interpretation of Pulmonary Function Tests, 4th edition provides practical, clinically relevant coverage of all types of pulmonary function testing as it applies to a host of disease conditions. 0000050609 00000 n Before PFT results can be reliably interpreted, three factors must be confirmed: (1) the volume-time curve reaches a plateau, and expiration lasts at least six seconds (Figure 2); (2) results of the two best efforts on the PFT are within 0.2 L of each other (Figure 3); and (3) the flow-volume loops are free of artifacts and abnormalities.5 If the patient's efforts yield flattened flow-volume loops, submaximal effort is most likely; however, central or upper airway obstruction should be considered. Pulmonary function tests (PFTs) are a group of tests that measure how well your lungs work. e source of air leak, could be loose tube connections or a patient who cannot, e two major obstructive disorders are asthma and chronic, obstructive airway disease. e interpretation is done by the following methods: with the knowledge of traditional patterns produced by, various diseases. 5). New techniques based on physiologic concepts that were first described almost 50 years ago are emerging in research and in clinical practice for measuring pulmonary function in children. If pulmonary function test … Spirometry is a simple and informative test for evaluating airflow obstruction. � �8��KZ@ƪ� �w��:��90��$(�C.��6u ��n��bR�-��"b� Ac��=�P^A��|K��ٗ��zu��|5��nu��X�n��j��e��_�@R�΋V��;`t��Ni>�Q�&��j�$A��QR `EAJ�rI�hK.8)i�D2�Gv4J��Ǯ$�RqRp�y��IRVO�=��(�"��E��P��'�Py,��~�M��v=�8M��b��ד+�^OЮ��WQZ�`P`��ϸ��\�`k�p8v{gU Patients may. 0000015255 00000 n Magnitude of, change in reection of sounds indicates the pathological. In book: Progress in Medicine 2020 (pp.519). Impulse oscillometry (IOS) permits passive measurement, of lung mechanics. Corpus ID: 23043980. It is the authors’ stated aim to produce a concise and practical guide to the interpretation of pulmonary function tests. There are two reasons for performing pulmonary function tests, including maximal respiratory pressure tests, in patients with neuromuscular disease. IOS can dierentiate small, airway obstruction from large airway obstruction and, is more sensitive than spirometry for peripheral airway, disease. sample of the general US population. @article{Acres1981ClinicalSO, title={Clinical significance of pulmonary function tests: upper airway obstruction. Pulmonary function testing (PFT) is a complete evaluation of the respiratory system including patient history, physical examinations, and tests of pulmonary function. INTRODUCTION. Dyspnea is a subjective sensation of difficult or uncomfortable breathing experienced by the patient. ~ PDF Interpretation Of Pulmonary Function Tests ~ Uploaded By Georges Simenon, interpreting pulmonary function tests that will allow him or her to recognize and quantitate abnormalities before interpreting the results one should ascertain that the test was acceptable and reproducible and that the patients demographic data are correct pattern recognition is keya low fev 1 fvc ratio the forced … Describe the clinical indications for pulmonary function testing 2. `��G�p2� q��b�S��F]�eq�ez⡩�% �>��8�8��af'��}��C��"�v��Ol>��j�/zS��Nm�Y��pK��ǻU,Ydt6V��1�[g��ߥk�׵ӳ�Xx�y�0R�}�Q�E�S3vN9x$c��Jʮ�7צ��:��&��D�R��#g�Z�'i�iXt��ՕQ�{%��71�wW�z�3˸W�ײ�� Disorders of acid-base balance can lead to severe complications in many disease states, and occasionally the abnormality may be so severe as to become a life-threatening risk factor. Basic algorithm for interpretation of pulmonary function test. 0000009400 00000 n with parameters of a matched normal subject. J Appl Physiol. ^ PDF Interpretation Of Pulmonary Function Tests ^ Uploaded By John Creasey, interpretation of pulmonary function tests and impulse oscillometry in clinical practice characteristics of an ideal flow volume curve poor end of test coughing within 1 second of interpreting pulmonary function tests that will allow him or her to recognize and quantitate abnormalities before interpreting the results one should … 0000011921 00000 n PDF | Interpretation of Pulmonary Function Tests and Impulse Oscillometry in clinical practice | Find, read and cite all the research you need on ResearchGate 0000023988 00000 n Medical Director Respiratory Care & Pulmonary Rehab McLaren Bay Region. 0000017081 00000 n Therefore, attempts to interpret pulmonary function tests solely on the basis of predesignated numerical standards has so many pitfalls that it may easily supply gross misinterpretations. Simple spirometry and body plethysmography have been routinely used in children aged > 5 years. Pulmonary function testing has diagnostic and therapeutic roles and helps clinicians answer some general questions about patients … (A) V. R is nearly independent of oscillation frequency. yielded 130 patients who satisfied our criteria for spirometry evidence of combined obstruction and restriction. In 18 patients (14%) no clear etiology of combined obstruction and restriction could be determined. ~�u@��K.�6bK�XS~� �(�8��L\6�^�`qĜ!�h�I�^ +��,f�,,E,�,9kb�0�!��q�u�r�k�Κ�#�e� �Y� endstream endobj 115 0 obj 649 endobj 55 0 obj << /Type /Page /Parent 51 0 R /Resources 56 0 R /Contents [ 65 0 R 73 0 R 83 0 R 85 0 R 87 0 R 89 0 R 93 0 R 95 0 R ] /MediaBox [ 0 0 576 774 ] /CropBox [ 0 0 576 774 ] /Rotate 0 >> endobj 56 0 obj << /ProcSet [ /PDF /Text ] /Font << /F2 91 0 R /F4 70 0 R /F6 80 0 R /F8 78 0 R /F12 75 0 R /F14 74 0 R /F16 62 0 R /F18 67 0 R /F20 69 0 R /F22 57 0 R /F24 61 0 R >> /ExtGState << /GS1 113 0 R /GS2 107 0 R /GS3 101 0 R >> >> endobj 57 0 obj << /Type /Font /Subtype /Type1 /Name /F22 /FirstChar 9 /LastChar 255 /Widths [ 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 278 389 556 556 556 1000 722 278 333 333 556 600 278 333 278 278 556 556 556 556 556 556 556 556 556 556 278 278 600 600 600 500 800 722 611 611 722 556 500 722 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<< /Filter /FlateDecode /Length 64 0 R >> stream glass box of the size of a telephone booth, and does the. first second (FEV1). bronchial asthma, cannot expand enough to accommodate the amount of. 13. 159: 179-187, Peak flowmeter resistance decreases peak expiratory flow in subjects with COPD, Guidelines for methacholine and exercise challenge testing - 1999, Spirometry: a key diagnostic test in pulmonary medicine. FEV, preserved or increased. include several parameters as tabulated in Table 1. SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” Edited by V. Brusasco, R. Crapo and G. Viegi Number 5 in this Series This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTs most commonly … Basic Information on Pulmonary Function Testing; A General Approach to Interpreting Pulmonary Function Tests; Pre-Test; Cases in Pulmonary Function Test Interpretation: Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Case 7; Case 8; Case 9; Case 10; Case 11; Case 12; Post-Test The process of analysis and monitoring of arterial blood gas (ABG) is an essential part of diagnosing and managing the oxygenation status and acid-base balance of the high-risk patients, as well as in the care of critically ill patients in the Intensive Care Unit. We electronically sent a survey to 55 pulmonary physicians, of whom 30 (55%) responded. e central intra-thoracic airways, narrow when they are compressed by the increased. Diusion capacity of the lungs for carbon monoxide, Bronchodilator and bronchial challenge testing. Historically, simple equations using age, height, and sex were used to “predict” normal lung function. BACKGROUND: Pulmonary function tests (PFTs) are commonly inter-preted as a fraction of predicted normal values, with an abnormal test often defined as less than 80% or greater than 120% of the predicted value. e information, when critically analyzed and interpreted provides objective, evidence of patients’ current respiratory functions and can, even be used to follow-up patients on therapy. 0000002417 00000 n 0000241065 00000 n (A, e width of the FVC may be decreased as compared to, In emphysema because of loss of supportive tissues, the, PEF can be normal initially due to increased elastic, Slope of the descending limb is steeper than usual, e steep descending limb and narrow width of the FV, PEF is decreased as the elastic recoil of the lung is not, e curve of the slope is parallel to the predicted, ere may be a rapid decline in ows at the end of, Various patterns in restrictive lung diseases. 0000022770 00000 n 0000037706 00000 n R5 or R6 and R20 both are. However, recommendations of the American Thoracic Society/European … This method can be used to assess obstruction in the large and small peripheral airways and has been used to measure bronchodilator response and bronchoprovocation testing. R5 or R6 is, frequencies and falls with increasing frequency known. Measurements from a forced expiratory maneuver are conventionally displayed as volume vs time (spirogram) and flow vs volume (flow-volume loop) tracings. 19. Sood P, Paul G, Puri S. Interpretation of arterial blood gas. Interpretation of Pulmonary Function Test: Issues and Controversies 0000018237 00000 n Nevertheless, some test patterns strongly suggest the presence of certain conditions, such … 0000010548 00000 n 0000004493 00000 n 0000016846 00000 n 10A). These patients are usually wrongly labelled as difficult-to-treat asthma and consequently experience significant morbidity. The most common pulmonary disease was chronic obstructive pulmonary disease (45/130, 35%), and the most common non-parenchymal disease was congestive heart failure (27/130, 21%). In all cases of obstruction there will be a reduction in expiratory flow as noted on the spirogram. 0000129547 00000 n residual volume (RV) and underestimates the FVC. e ideal FV curve should have the, membrane, thickness of the membrane, and the dierence, in the oxygen tension between the alveolar gas and the, They are useful adjuncts to a baseline PFT. 0000023398 00000 n Interpretation of Pulmonary Function Tests: A Practical Guide. ventilatory defect is determined by visual impression. This article reviews the clinical applications of IOS, with an emphasis on the pediatric setting, and discusses appropriate coding practices for the clinician. Many methods do exist in literature to guide the interpretation of the ABGs. 2000;89:283-90. 10B). e VC value used in the algorithm, refers to the largest of any VC maneuver regardless of how, it was obtained. 0000228055 00000 n Access scientific knowledge from anywhere. 0000024102 00000 n 0000177692 00000 n is is not a very sensitive technique, and the disorders are usually advanced by the time they are, picked up by this technique. Pulmonary function tests PFTs are noninvasive tests that show how well the lungs are working. The key to the diagnosis is, be reduced as well but to a lesser extent as the FEV, concavity being more pronounced as the severity of the, obstruction increases. This is when air has trouble flowing out of the lungs due to airway resistance. 2002;166:518. function testing in the pulmonary function laboratory. 0000006986 00000 n e downward convexity indicates premature, cessation of expiration or inhalation before reaching. Examples of post bronchodilator reversibility. Hyatt RE, Scanlon PD, Nakamura M. (Pp 212; £30.50). do not meet and are separated by a small gap (Fig. �d��c~#� tJNk�+�"�'�"]@H��ߘddn�� This chapter provides a structured approach to analyzing and interpreting the many data points necessary to provide an accurate assessment of normal and abnormal pulmonary function tests. Clin Chest Med. FVC may, e height of the PEF is less than predicted, e descending limb is concave (“scooped”) with the, Examples of post bronchodilator reversibility. Am j Respir Crit Care Med. © 2008-2021 ResearchGate GmbH. 0000103092 00000 n 0000012165 00000 n Characteristics of an ideal ow–volume curve. Since both areas manifest sudden and life-threatening changes in all the systems concerned, a thorough understanding of acid-base balance is mandatory for any physician, and the anesthesiologist is no exception. interpreting pulmonary function tests that will allow him or her to recognize and quantitate abnormalities. It might be pulmonary or cardiac in origin. ey are helpful in patients with neuromuscular, disease to assess respiratory muscle strength, which is more, sensitive than spirometry or MVV to assess impending, respiratory failure. In this revised 5th Edition, Dr. Paul D. Scanlon expands upon the tradition of excellence begun by renowned pulmonary physiologist and father of the flow-volume curve, Dr. Robert E. Hyatt. (B) Insignificant reversibility. Clinical significance of pulmonary function tests: upper airway obstruction. present with expiratory wheeze (Fig. The proper application of the concepts of acid-base balance will help the healthcare provider not only to follow the progress of a patient, but also to evaluate the effectiveness of care being provided. Can Respir J 2009;16(6):189-193. trailer << /Size 116 /Info 50 0 R /Root 54 0 R /Prev 416443 /ID[<8b2a576ff8dac2ff6b3f072181df29ba><128377a3db6954fc4c297e6d35900328>] >> startxref 0 %%EOF 54 0 obj << /Type /Catalog /Pages 51 0 R /Metadata 52 0 R >> endobj 114 0 obj << /S 630 /Filter /FlateDecode /Length 115 0 R >> stream Chest. ��£p��C��4��:>��,�s�|��Fv��&��2f�4Xvx��f�K��rZ:1��4`�1 In variable extra-thoracic obstruction, the, airway obstruction, which is mobile, is above the level of, the sternal notch and occurs during inspiration due to. practical applications. Significant, improvement in measured dynamic parameters [forced, expiratory volume in 1 s (FEV1) or forced vital capacity, (FVC)] following bronchodilator use (change of ≥12% and, volume change >200 mL) indicates signicant reversible, airway obstruction. However, these multiple factors interact in complex ways to determine what the expected lung function values are in healthy subjects. e lung compliance is, reduced while the elasticity is increased. The FEV1 will be reduced. Patients usually present with a stridor or wheeze (Fig. is used to dene the severity of the disease. Understand the physiology of the core pulmonary function tests: spirometry, lung volumes and DLCO 3. Am J Respir Crit Care Med. e common terminologies, Sounds of lower frequency (<15 Hz) travel to the lower, airways and are reected whereas higher frequency (>20 Hz), sounds are reected from higher airways. Description. 0000004269 00000 n “Scalloped” curve in obstructive airway disease and post bronchodilator response. As a simple, inexpensive, and informative test, spirometry should be used liberally in assessing patients with respiratory symptoms. 0000254511 00000 n Vocal cord disorders are a group of conditions uncommonly leading to dyspnea. For interpretation of PFT reports of a particular patient, one must keep in mind that there is great physiological. }, author={J. The procedures are based on the current standards for pulmonary function, equipment, testing, and interpretation set by the American Thoracic Society (ATS).5,6 Spirometry training is required for all health technologists and will be provided by NIOSH. Causes of intra-thoracic and extra-thoracic obstructions. To describe a pathway (algorithm) for interpreting PFTs, in a diagnostic sense, from measurements of spirometry (forced expiratory volume in 1 s (FEV1)) and forced vital capacity (FVC)), lung volume (total lung capacity (TLC)) and gas transfer and coefficient (transfer factor for the lung for carbon monoxide … Pulmonary Function Tests • The term encompasses a wide variety of objective tests to assess lung function • Provide objective and standardized measurements for assessing the presence and severity of respiratory dysfunction. All rights reserved. 0000020661 00000 n IOS parameters can pick up early changes in lung, functions and are superior to spirometry in predicting loss, of control in asthmatic patients. Am J Respir Crit Care Med. Pulmonologists' impressions regarding the frequency and causes are generally discordant with the observed frequencies. 0000115947 00000 n Pulmonary function tests help to answer the question. 0000001681 00000 n INTERPRETATION OF PULMONARY FUNCTION TESTS (PFTS) Anna Neumeier, MD Assistant Professor, Department of Pulmonary Sciences and Critical Care Medicine ACP February 2020. If both the FEV1/FVC ratio and the FVC are low, the patient has a mixed defect. Spirometric reference values from a sample of the general U.S. population. The common terminologies used in interpretation are, independent of frequency, i.e. It also has a role in documenting high, expiratory pressures in patients of cough syncope as well, where expiratory pressures can cross 300 cm H, e rst step in interpretation is to identify the type of lung, or complete obstruction at any level of the airway leading. is indicates a poor initial eort by the, upward convexity and not a downward convexity as in, Figure 3. Cough, beyond the rst second is less likely to have an impact. )))�et@T.��U@��!��0MVq CR3]��5,Y#PgX�*�fe747(��F �ր+� ��0��ik � Q�]�Y�N1�f�d�bIf8L�Y�N�d1�3300�f�f�`8�p�%��K>�%�� variability in the parameters of patients with age, sex, height, weight, race, etc. ISBN 0 316 26261 7. 0000008130 00000 n In spirometry, a device called a spirometer is used to measure certain lung volumes, called dynamic lung volumes. c��q�xI �ؿ?��{��`B��c$��!�@�q��ǟ��A��3�w�h΋bJ�Yp�Au��@ocTk��M��:��93$L`m&*C��׍k��ܾ��a�� ` )�K endstream endobj 66 0 obj << /Type /FontDescriptor /Ascent 750 /CapHeight 698 /Descent -216 /Flags 262176 /FontBBox [ -112 -250 1000 940 ] /FontName /Frutiger-BoldCn /ItalicAngle 0 /StemV 124 /XHeight 515 /FontFile3 111 0 R >> endobj 67 0 obj << /Type /Font /Subtype /Type1 /Name /F18 /FirstChar 9 /LastChar 255 /Widths [ 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 250 333 444 500 500 833 833 278 389 389 500 606 333 333 333 278 500 500 500 500 500 500 500 500 500 500 333 333 606 606 606 389 747 722 611 722 722 611 556 778 778 333 333 667 556 889 778 778 556 778 611 500 667 778 667 944 667 556 556 278 606 278 606 500 333 444 444 389 444 389 278 389 444 222 222 444 222 722 500 444 444 444 333 333 278 500 444 667 444 444 389 278 606 278 606 250 722 722 722 611 778 778 778 444 444 444 444 444 444 389 389 389 389 389 222 222 222 222 500 444 444 444 444 444 500 500 500 500 500 400 500 500 500 606 628 500 747 747 979 333 333 0 944 778 0 606 0 0 500 500 0 0 0 0 0 500 500 0 667 444 389 333 606 0 500 0 0 500 500 1000 250 722 722 778 944 722 500 1000 444 444 278 278 606 0 444 556 167 0 333 333 500 500 500 333 278 444 1000 722 611 722 611 611 333 333 333 333 778 778 0 778 778 778 778 222 333 333 333 333 333 333 333 444 333 333 ] /Encoding 60 0 R /BaseFont /Goudy-Italic /FontDescriptor 68 0 R >> endobj 68 0 obj << /Type /FontDescriptor /Ascent 745 /CapHeight 704 /Descent -203 /Flags 98 /FontBBox [ -167 -214 1006 951 ] /FontName /Goudy-Italic /ItalicAngle -7 /StemV 73 /XHeight 437 /FontFile 108 0 R >> endobj 69 0 obj << /Type /Font /Subtype /Type1 /Name /F20 /FirstChar 9 /LastChar 255 /Widths [ 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 260 370 519 520 520 833 648 260 296 296 519 600 260 315 260 278 520 520 520 520 520 520 520 520 520 520 260 260 600 600 600 463 800 611 556 556 630 500 463 648 611 278 352 574 444 815 648 648 519 648 556 500 481 611 574 833 574 556 500 296 278 296 600 500 222 500 537 426 537 500 333 537 519 260 260 500 260 778 519 537 537 537 352 407 352 519 481 741 463 463 407 333 222 333 600 260 611 611 556 500 648 648 611 500 500 500 500 500 500 426 500 500 500 500 260 260 260 260 519 537 537 537 537 537 519 519 519 519 520 400 520 520 519 500 600 537 800 800 1000 222 222 0 833 648 0 600 0 0 520 519 0 0 0 0 0 352 352 0 776 537 463 370 600 0 520 0 0 519 519 1000 260 611 611 648 833 815 500 1000 519 519 260 260 600 0 463 556 167 0 296 296 574 574 520 259 260 519 926 611 500 611 500 500 278 278 278 278 648 648 0 648 611 611 611 260 222 222 222 222 222 222 222 222 222 222 ] /Encoding 60 0 R /BaseFont /Frutiger-BoldCn /FontDescriptor 66 0 R >> endobj 70 0 obj << /Type /Font /Subtype /Type1 /Name /F4 /Encoding 71 0 R /BaseFont /ZapfDingbats >> endobj 71 0 obj << /Type /Encoding /Differences [ 128 /a89 /a90 /a93 /a94 /a91 /a92 /a205 /a85 /a206 /a86 /a87 /a88 /a95 /a96 ] >> endobj 72 0 obj 690 endobj 73 0 obj << /Filter /FlateDecode /Length 72 0 R >> stream to impairment of exhalation, e.g. Review of polysomnographic techniques and interpretive strategies again with a practical hands-on approach. intra-thoracic pressure which occurs during expiration. A survey to 55 pulmonary physicians, of the general U.S. population prominent, during expiration informative test spirometry! The American Thoracic Society recommendations, and African-American subjects had lower values volumes and DLCO 3, the... The above factors in mind and compared U.S. population many other diagnostic tests in healthy subjects can your... And research you need to help your healthcare provider diagnose and decide treatment... Evaluated by a small gap ( Fig concise and practical Applications, Hankinson JL, JR. Polysomnographic techniques and interpretive strategies again with a practical guide as difficult-to-treat asthma and consequently experience morbidity! Lungs for carbon monoxide, Bronchodilator and bronchial challenge testing IOS can dierentiate small airway. Evaluation of dyspnea, Impulse Oscillometry ( IOS ) permits passive measurement, of lung mechanics Bay Region indicates pathological. 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