By E. Eber, F Midulla
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Extra resources for ERS Handbook of Paediatric Respiratory Medicine
The right main bronchus gives off the right upper lobe bronchus and continues as the bronchus intermedius. This divides into the right middle and lower lobe bronchi. The right upper lobe bronchus divides into three segmental bronchi: apical, posterior and anterior. The right middle lobe bronchus divides into two: the medial and lateral segments of the middle lobe. The right lower lobe bronchus gives off a superior segmental branch and then medial, lateral, anterior and posterior segments. Segmental bronchi are particularly important to recognise during bronchoscopy.
Visual inspection of the flow–volume loop is an essential part of the evaluation. g. caused by oedema of the airway epithelium mucosa) has a greater effect. When FEV1 and FVC are compared with predicted values both indices may be within normal limits, but in obstructive airway disease the FEV1/FVC ratio is usually reduced and this can be helpful in interpreting spirometry. However, FEV1/FVC should not be considered in isolation, because it cannot convey whether either or both component parts are within normal limits or not.
Measurements of absolute lung volumes are all based on determination of FRC, which may be influenced by the posture of the subject. The number of individual measurements performed may also affect the accuracy, and is generally higher for plethysmography than other techniques where a maximum of three determinations is usual. In contrast, the within-test repeatability of spirometry is generally good, making VC the index of choice for monitoring changes in restrictive disease. Where the restriction is due to a neuromuscular condition, spirometry may be more variable and the flow–volume loop can give the impression of inconsistency of effort; in these cases the operator must be alert to the tiring effect of repeated forced manoeuvres and avoid too many unnecessary and fruitless attempts at achieving higher values of VC.
ERS Handbook of Paediatric Respiratory Medicine by E. Eber, F Midulla