Applied Lung Physiology

  • Brendan G. CooperEmail author
  • William Tunnicliffe


This chapter has been written by two clinicians with immense experience in the measurement and interpretation of lung function testing; one a physician and one a physiologist, but both extremely passionate about educating others in understanding lung function. As an introduction to lung function testing for the trainee respiratory physician, this chapter covers some of the essential questions including “Why test lung function?”, “What’s normal and abnormal lung function?”, and “What are the basic principles of the main lung function tests?”

The chapter has a simple overview of spirometry and its interpretation and then moves on to the various lung volume measurements commonly used. The only real test of gas exchange function—the gas transfer test—is covered in reasonable detail. Whilst these measurements probably cover 80% of the normal requests for lung function testing, the methods for respiratory muscle assessment are essential for trainees to understand and use when they diagnose and treat these patients.

Finally, cardiopulmonary exercise testing is given an overview to give you the essential features on what is a very complex physiological measurement which is often poorly understood. The reader will have a teaser of the usefulness of lung function testing. You will be challenged to interpret tests without “percentage of predicted” and the errors it introduces and you will have an excellent overview albeit an “aide-memoire” of the basics of clinical respiratory physiology.


Spirometry Lung function testing Lung volumes Gas transfer test Respiratory muscle assessment Cardiopulmonary exercise testing CPET 


  1. 1.
    Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005;26(1):153–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26(4):720–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(3):511–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.CrossRefGoogle Scholar
  6. 6.
    American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144(5):1202–18.CrossRefGoogle Scholar
  7. 7.
    Cooper BG. Review: an update on contraindications for lung function testing. Thorax. 2011;66:714–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Krogh M. The diffusion of gases through the lungs of man. J Physiol. 1914;49:271–300.CrossRefGoogle Scholar
  9. 9.
    Roughton FJW, Forster REJ. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol. 1957;11(2):290–302.CrossRefPubMedGoogle Scholar
  10. 10.
    Blakemore WS, Forster RE, Morton JW, Ogilvie CM. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Investig. 1957;36:1–17.CrossRefPubMedGoogle Scholar
  11. 11.
    Polkey MI, Green M, Moxham J. Measurement of respiratory muscle strength. Thorax. 1995;50:1131–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Black L, Hyatt R. Maximal respiratory pressures: normal values and relationships to age and sex. Am Rev Respir Dis. 1969;99:698–702.Google Scholar
  13. 13.
    Wilson SH, Cooke NT, Edwards RH, Spiro SG. Predicted normal values for maximal respiratory pressures in caucasian adults and children. Thorax. 1984;39:535–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bruschi C, Cerveri I, Zoia MC, Fanfulla F, Fiorentini M, Casali L, et al. Reference values of maximal respiratory mouth pressures: a population based study. Am Rev Respir Dis. 1992;146:790–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Miller JM, Moxham J, Green M. The maximal sniff in the assessment of diaphragm function in man. Clin Sci. 1985;69:91–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Hamnegard CH, Wragg S, Kyroussis D, Mills GH, Polkey MI, Moxham J, et al. Sniff nasal pressure measured with a portable meter. Am J Respir Crit Care Med. 1995;151:A415.Google Scholar
  17. 17.
    Uldry C, Fitting JW. Maximal values of sniff nasal inspiratory pressure in healthy subjects. Thorax. 1995;50:371–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Lung Function and Sleep DepartmentQueen Elizabeth HospitalBirminghamUK
  2. 2.Respiratory and Critical Care MedicineQueen Elizabeth HospitalBirminghamUK

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