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Interpretative strategies for lung function tests

R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, F. Burgos, R. Casaburi, A. Coates, C. P. M. van der Grinten, P. Gustafsson, J. Hankinson, R. Jensen, D. C. Johnson, N. MacIntyre, R. McKay, M. R. Miller, D. Navajas, O. F. Pedersen, J. Wanger
European Respiratory Journal 2005 26: 948-968; DOI: 10.1183/09031936.05.00035205
R. Pellegrino
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G. Viegi
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V. Brusasco
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R. O. Crapo
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F. Burgos
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R. Casaburi
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A. Coates
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C. P. M. van der Grinten
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P. Gustafsson
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J. Hankinson
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R. Jensen
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D. C. Johnson
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N. MacIntyre
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R. McKay
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M. R. Miller
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D. Navajas
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O. F. Pedersen
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J. Wanger
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Figures

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  • Figure1
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  • Fig. 1—
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    Fig. 1—

    a, b) Examples of obstructive pulmonary defects with a low (a; forced expiratory volume in one second (FEV1) 38%; FEV1/vital capacity (VC) 46%; peak expiratory flow (PEF) 48%; total lung capacity (TLC) 101%) or normal (b; FEV1 57%; FEV1/VC 73%; PEF 43%; TLC 96%) ratio of FEV1/VC. In both cases, TLC is normal, and flows are less than expected over the entire volume range. c) Example of a typical restrictive defect (FEV1 66%; FEV1/VC 80%; PEF 79%; TLC 62%). The TLC is low and flow is higher than expected at a given lung volume. d) Example of a typical mixed defect characterised by a low TLC and a low FEV1/VC ratio (FEV1 64%; FEV1/VC 64%; PEF 82%; TLC 72%). – – – –: predicted flow–volume curves; ––––: observed inspiratory and expiratory flow–volume curves (as indicated in a).

  • Fig. 2—
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    Fig. 2—

    A simplified algorithm that may be used to assess lung function in clinical practice. It presents classic patterns for various pulmonary disorders. As in any such diagram, patients may or may not present with the classic patterns, depending on their illnesses, severity and lung function prior to the disease onset (e.g. did they start with a vital capacity (VC) close to the upper or lower limits of normal (LLN)). The decisions about how far to follow this diagram are clinical, and will vary depending on the questions being asked and the clinical information available at the time of testing. The forced expiratory volume in one second (FEV1)/VC ratio and VC should be considered first. Total lung capacity (TLC) is necessary to confirm or exclude the presence of a restrictive defect when VC is below the LLN. The algorithm also includes diffusing capacity for carbon monoxide (DL,CO) measurement with the predicted value adjusted for haemoglobin. In the mixed defect group, the DL,CO patterns are the same as those for restriction and obstruction. This flow chart is not suitable for assessing the severity of upper airway obstruction. PV: pulmonary vascular; CW: chest wall; NM: neuromuscular; ILD: interstitial lung diseases; CB: chronic bronchitis.

  • Fig. 3—
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    Fig. 3—

    Idealised examples of a) fixed, b) variable extrathoracic, and c) variable intrathoracic airway obstruction.

  • Fig. 4—
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    Fig. 4—

    Example of unilateral main bronchus obstruction due to a valve-like mechanism occluding the main left stem bronchus during inspiration as a result of a surgical scar. There is a delay in gas filling towards the end of the forced inspiration as evidence of the variable unilateral main bronchus obstruction (forced expiratory volume in one second (FEV1): 76%; FEV1/vital capacity: 70%; peak expiratory flow: 93%; total lung capacity: 80%). -----: predicted expiratory flow–volume loop; ––––: recorded maximum inspiratory and expiratory flow–volume loops.

Tables

  • Figures
  • Table. 1—

    Outcomes of a MEDLINE search using the keywords“reference equations” and “spirometry”

    First authorYearCountry/area/nature of studyJournal
    Kotaniemi2004Finland; adultsInt J Circumpolar Health 2004; 63: 129–139
    Subbarao2004Canada; comparison of referencesPediatr Pulmonol 2004; 37: 515–522
    Falaschetti2004England; prediction equations from the Health SurveyEur Respir J 2004; 23: 456–463
    Botsis2003Greece; neural networks for the prediction of spirometric reference values in the elderlyMed Inform Internet Med 2003; 28: 299–309
    Ben Saad2003Tunisia; vital capacity and peak expiratory flow rates in the elderlyRev Mal Respir 2003; 20: 521–530 (French)
    Mustajbegovic2003Croatia; comparison with European reference valuesCroat Med J 2003; 44: 614–617
    Perez-Padilla2003Mexico; comparison with Mexican American childrenPediatr Pulmonol 2003; 35: 177–183
    Torres2003Brazil; height and arm span in childrenPediatr Pulmonol 2003; 36: 202–208
    Golshan2003IranEur Respir J 2003; 22: 529–534
    Mohamed2002ItalyLung 2002; 180: 149–159
    Boskabady2002IranRespiration 2002; 69: 320–326
    Havryk2002Himalayan SherpasRespir Physiol Neurobiol 2002; 132: 223
    Dejsomritrutai2002ThailandRespirology 2002; 7: 123–127
    Langhammer2001NorwayEur Respir J 2001; 18: 770–779
    Milivojevic-Poleksic2001Pacific IslandRespirology 2001; 6: 247–253
    Marion2001USA; American IndianChest 2001; 120: 489–495
    Kivastik2001Estonia; school childrenClin Physiol 2001; 21: 490–497
    Manzke2001Germany; children aged 6–16 yrs from “hospital normals”Eur J Pediatr 2001; 160: 300–306
    Perez-Padilla2001Mexico; Mexican workersSalud Publica Mex 2001; 43: 113–121 (Spanish)
    Pistelli2000ItalyAm J Respir Crit Care Med 2000; 161: 899–905
    Vijayan2000India; South Indian childrenIndian J Chest Dis Allied Sci 2000; 42: 147–156
    Baltopoulos2000Greece; Greek elderlyLung 2000; 178: 201–212
    Ip2000Chinese children and adolescents in Hong KongAm J Respir Crit Care Med 2000; 162: 424–429
    Dejsomritrutai2000ThailandJ Med Assoc Thai 2000; 83: 457–466
    Quadrelli1999ItalyRespir Med 1999; 93: 523–535
    Morato Rodriguez1999Spain; children of Basque Autonomic CommunityAn Esp Pediatr 1999; 51: 17–21 (Spanish)
    Crapo1999Comparison of Mongolians/CaucasiansEur Respir J 1999; 13: 606–609
    Hankinson1999USA population sample, aged 8–80 yrs (NHANES III)Am J Respir Crit Care Med 1999; 159: 179–187
    Baur1999Germany; comparison of lung function reference valuesInt Arch Occup Environ Health 1999; 72: 69–83
    McDonnell1998USA; older adultsRespir Med 1998; 92: 914–921
    Martin1998Canada; QuebecRev Mal Respir 1998; 15: 781–788 (French)
    Castellsague1998ECRHS; European populationsRespir Med 1998; 92: 401–407
    Roca1998ECRHS; validationEur Respir J 1998; 11: 1354–1362
    Pan1997China; TaiwanChin J Physiol 1997; 40: 165–174
    Rajkappor1997India; school childrenIndian J Chest Dis Allied Sci 1997; 39: 97–105
    Luttmann1997Germany; 7–18-yr-old probandsPneumologie 1997; 51: 47–54 (German)
    Chin1997Singapore; nonsmoking adultsRespirology 1997; 2: 143–149
    Oyarzun1996ChileRev Med Chil 1996; 124: 1365–1367 (Spanish)
    Gutierrez1996Chilean population >5 yrs oldRev Med Chil 1996; 124: 1295–1306 (Spanish)
    Enright1996USA; elderly BlacksChest 1996; 110: 1416–1424
    Diez-Herranz1996Comparison reference values recommended by the pneumology Spanish and European societiesArch Bronconeumol 1996; 32: 459–462 (Spanish)
    Louw1996South African males (normative values)S Afr Med J 1996; 86: 814–819
    Parma1996Male Italians aged 7–18 yrsEur J Epidemiol 1996; 12: 263–277
    Giri1996BhutanJ Assoc Physicians India 1996; 44: 320–322
    Brandli1996Adult Swiss populationThorax 1996; 51: 277–283
    Sharp1996Japanese-American males aged 71–90 yrsAm J Respir Crit Care Med 1996; 153: 805–811
    Quintero1996Healthy Nicaraguan male workersAm J Ind Med 1996; 29: 41–48
    Enright1995USA; healthy Minnesota 65–85-yr-old males and femalesChest 1995; 108: 663–669
    Sirotkovic1995Croatia; school children from DalmatiaMonaldi Arch Chest Dis 1995; 50: 258–263
    Gore1995Healthy adult lifetime nonsmokers in AustraliaEur Respir J 1995; 8: 773–782
    Quanjer1995White European children and adolescentsPediatr Pulmonol 1995; 19: 135–142
    Dufetel1995Togo; Senegalese Black children and adolescentsRev Mal Respir 1995; 12: 135–143 (French)
    Fulton1995USA; MVV in African American adolescent femalesPediatr Pulmonol 1995; 20: 225–233
    • NHANES: National Health and Nutrition Examination Survey; ECRHS: European Community Respiratory Health Survey; MVV: maximum voluntary ventilation.

  • Table. 2—

    Outcomes of a MEDLINE search under the keywords“reference equations” and “lung volumes”

    First authorYearCountry/area/nature of studyJournal
    Torres2003Brazil; height and arm span in childrenPediatr Pulmonol 2003; 36: 202–208
    Verma2003India; dimensional statistics for estimation of lung volumes in children and adolescentsAnthropol Anz 2003; 61: 79–84
    Neve2002France; puberty and thoracic volume indexEur Respir J 2002; 20: 1292–1298
    Zheng2002China; survey on clinical applicationZhonghua Jie He He Hu Xi Za Zhi 2002; 25: 69–73 (Chinese)
    Manzke2001Germany; children aged 6–16 yrs from “hospital normals”Eur J Pediatr 2001; 160: 300–306
    Cotes2001UK workers; body mass indexThorax 2001; 56: 839–844
    Ip2000Chinese children and adolescents in Hong KongAm J Respir Crit Care Med 2000; 162: 424–429
    Neder1999BrazilBraz J Med Biol Res 1999; 32: 729–737
    Baur1999Germany; comparison of lung function reference valuesInt Arch Occup Environ Health 1999; 72: 69–83
    Cordero1999Latin population of Spanish descentRespiration 1999; 66: 242–250
    Roca1998SpainRespir Med 1998; 92: 454–460
    Corzo-Alvarez1998Nonsmoking healthy males in Maracaibo, VenezuelaInvest Clin 1998; 39: 3–17 (Spanish)
    Mahajan1997Healthy females of HaryanaIndian J Chest Dis Allied Sci 1997; 39: 163–171
    Chin1997Singapore; nonsmoking adultsRespirology 1997; 2: 143–149
    McCoy1995USA; normal infantsPediatr Pulmonol 1995; 19: 282–290
    Rosenthal1993UK; body plethysmographic gas volumes in prepubertal and pubertal school children in LondonThorax 1993; 48: 803–808
  • Table. 3—

    Outcome of a MEDLINE search under the keywords“reference equations” and “diffusing capacity” or “diffusion”

    First authorYearCountry/area/nature of studyJournal
    Neve2002France; puberty and thoracic volume indexEur Respir J 2002; 20: 1292–1298
    Zheng2002China; survey on clinical applicationZhonghua Jie He He Hu Xi Za Zhi 2002; 25: 69–73 (Chinese)
    Zanen2001The Netherlands; alveolar membrane diffusion capacity and pulmonary capillary blood volumeEur Respir J 2001; 18: 764–769
    Cotes2001UK workers; body mass indexThorax 2001; 56: 839–844
    Hughes2001UK; in defence of KCO (TL/VA)Eur Respir J 2001; 17: 168–174
    Johnson2000USA; correction for VA for both DL,CO and KCORespir Med 2000; 94: 28–37
    Neder1999BrazilBraz J Med Biol Res 1999; 32: 729–737
    Baur1999Germany; comparison of lung function reference valuesInt Arch Occup Environ Health 1999; 72: 69–83
    Martin1998Canada/QuébecRev Mal Respir 1998; 15: 781–788 (French)
    Mahajan1997India; healthy females of HaryanaIndian J Chest Dis Allied Sci 1997; 39: 163–171
    Chin1997Singapore; nonsmoking adultsRespirology 1997; 2: 143–149
    Guenard1996France; elderly subjectsEur Respir J 1996; 9: 2573–2577
    Collard1996Belgium; obstructive sleep apnoea and obesityChest 1996; 110: 1189–1193
    Chinn1996UK workers; standardised for alveolar volumeEur Respir J 1996; 9: 1269–1277
    Stam1996The Netherlands; at reduced alveolar volumes in childrenPediatr Pulmonol 1996; 21: 84–89
    • KCO: transfer coefficient of the lung for carbon monoxide; TL: transfer factor of the lung; VA: alveolar volume; DL,CO: carbon monoxide diffusing capacity.

  • Table. 4—

    Summary of the usage of reference values

    ItemReference values
    GeneralPredicted values should be obtained from studies of “normal” or “healthy” subjects with the same anthropometric (e.g. sex, age and height) and ethnic characteristics of the patient being tested
    Height and weight should be measured for each patient at the time of testing
    If possible, all parameters should be taken from the same reference source
    When comparing selected reference equations with measurements performed on a sample of healthy subjects in a laboratory, it is suggested to choose the reference equation that provides the sum of residuals (observed – predicted computed for each adult subject, or log observed – log predicted for each subject in the paediatric age range) closest to zero
    When using a set of reference equations, extrapolation beyond the size and age of the investigated subjects should be avoided
    For each lung function index, values below the 5th percentile of the frequency distribution of values measured in the reference population are considered to be below the expected “normal range”
    SpirometryIn the USA, ethnically appropriate NHANES III reference equations published in 1999 for those aged 8–80 yrs, and the equations of Wang et al. 29 for children aged <8 yrs are recommended
    In Europe, the ECCS combined reference equations published in 1993 8 are often used for 18–70-yr-old people, and those from Quanjer et al. 30 for paediatric ages
    Currently, a specific set of equations is not recommendable for use in Europe. A new Europe-wide study to derive updated reference equations for lung function is needed
    Table 1 includes reference equations published from 1995 to August 2004
    Lung volumesNo specific set of equations can be recommended
    In practice, many USA and European laboratories use the reference equations for TLC, FRC and RV recommended by the 1995 ATS/ERS workshop 7 or by the ECCS in 1993 8
    Table 2 reports studies on reference equations published from 1993 to August 2004
    Diffusing capacityNo specific set of equations is generally recommended
    Commonly used equations appear to be those by the ECCS in 1993 38 and those of Crapo and Morris 40. In Europe, equations from Cotes et al. 41, Paoletti et al. 42 and Roca et al. 43 are also used
    Table 3 shows studies on reference equations published from 1995 to August 2004
    • NHANES: National Health and Nutrition Examination Survey; ECCS: European Community for Coal and Steal; TLC: total lung capacity; FRC: functional residual capacity; RV: residual volume; ATS: American Thoracic Society; ERS: European Respiratory Society.

  • Table. 5—

    Types of ventilatory defects and their diagnoses

    AbnormalityDiagnosis
    ObstructionFEV1/VC <5th percentile of predicted
    A decrease in flow at low lung volume is not specific for small airway disease in individual patients
    A concomitant decrease in FEV1 and VC is most commonly caused by poor effort, but may rarely reflect airflow obstruction. Confirmation of airway obstruction requires measurement of lung volumes
    Measurement of absolute lung volumes may assist in the diagnosis of emphysema, bronchial asthma and chronic bronchitis. It may also be useful in assessing lung hyperinflation
    Measurements of airflow resistance may be helpful in patients who are unable to perform spirometric manoeuvres
    RestrictionTLC <5th percentile of predicted
    A reduced VC does not prove a restrictive pulmonary defect. It may be suggestive of lung restriction when FEV1/VC is normal or increased
    A low TLC from a single-breath test should not be seen as evidence of restriction
    Mixed defectFEV1/VC and TLC <5th percentile of predicted
    • FEV1: forced expiratory volume in one second; VC: vital capacity; TLC: total lung capacity.

  • Table. 6—

    Severity of any spirometric abnormality based on the forced expiratory volume in one second(FEV1)

    Degree of severityFEV1 % pred
    Mild>70
    Moderate60–69
    Moderately severe50–59
    Severe35–49
    Very severe<35
    • % pred: % predicted.

  • Table. 7—

    Summary of the considerations for severity classification

    The severity of pulmonary function abnormalities is based on FEV1 % pred. This does not apply to upper airway obstruction. In addition, it might not be suitable for comparing different pulmonary diseases or conditions
    FEV1 may sometimes fail to properly identify the severity of a defect, especially at the very severe stages of the diseases
    FEV1 % pred correlates poorly with symptoms and may not, by itself, accurately predict clinical severity or prognosis for individual patients
    Lung hyperinflation and the presence of expiratory flow limitation during tidal breathing may be useful in categorising the severity of lung function impairment<1?twb?>
    • FEV1: forced expiratory volume in one second; % pred: % predicted.

  • Table. 8—

    Selected studies of bronchodilator response

    PopulationAgent/mode of deliveryFVCFEV1MEF25–75% or MEF50%Comments
    Selected population studies
     1063 subjects 8–75 yrs of age; general population 108IP 2 puffs via MDI10.7% (0.40 L)7.7% (0.31 L)20%95th percentile for per cent change from baseline
     2609 subjects; random sample of 3 areas in Alberta, Canada 109TB 500 µg via spacerMales 9% (0.34 L); females 9% (0.22 L)95th percentile for per cent change from baseline in asymptomatic never-smokers with FEV1 >80% pred
     75 selected normal subjects 110Two puffs via MDI5.1% (0.23 L)10.1% (0.36 L)48.3%Upper 95% CL (two-tailed) for per cent change from baseline
    Selected patient studies
     40 patients referred to PFT laboratory 112Placebo14.9% (0.34 L)12.3% (0.18 L)45.1%Upper 95% CI change after placebo
     985 COPD patients in the IPPB trial 111IP 250 µg via air nebuliser15%Per cent change from baseline
     150 patients with airway obstruction 113SB 200 µg or TB 500 µg via MDI15% (0.33 L)10% (0.16 L)95% CI for absolute change
     78 patients with COPD/asthma 101SB 200 µg via MDI14% (0.51 L)15% (0.25 L)95% CL per cent change of baseline
    • FVC: forced vital capacity; FEV1: forced expiratory volume in one second; MEF25–75%: mean flow between 25% and 75% of FVC; MEF50%: flow at 50% of FVC; IP: isoproterenol; MDI: metered dose inhaler; TB: terbutaline; % pred: % predicted; SB: salbutamol; CL: confidence limits; PFT:pulmonary function tests; CI: confidence interval; COPD: chronic obstructive pulmonary disease; IPPB: intermittent positive pressure breathing; Other variables as in table 6⇑.

  • Table. 9—

    Summary of the procedures relating to bronchodilator response

    Procedures suggested to minimise differences within and between laboratories
     Assess lung function at baseline
     Administer salbutamol in four separate doses of 100 µg through a spacer
     Re-assess lung function after 15 min. If you want to assess the potential benefits of a different bronchodilator, use the same dose and the same route as used in clinical practice. The wait time may be increased for some bronchodilators
    An increase in FEV1 and/or FVC ≥12% of control and ≥200 mL constitutes a positive bronchodilator response
    In the absence of a significant increase in FEV1 and/or FVC, an improvement in lung function parameters within the tidal breathing range, such as increased partial flows and decrease of lung hyperinflation, may explain a decrease in dyspnoea
    The lack of a bronchodilator response in the laboratory does not preclude a clinical response to bronchodilator therapy
    • FEV1: forced expiratory volume in one second; FVC: forced vital capacity.

  • Table. 10—

    Lung function parameters capable of differentiating extrathoracic from intrathoracic obstruction

    Extrathoracic obstructionIntrathoracic obstruction
    FixedVariable
    PEFDecreasedNormal or decreasedDecreased
    MIF50DecreasedDecreasedNormal or decreased
    MIF50/MEF50∼1<1>1
    • PEF: peak expiratory flow; MIF50: maximum inspiratory flow at 50% of forced vital capacity (FVC); MEF50: maximum expiratory flow at 50% of FVC.

  • Table. 11—

    Summary of the issues concerning central or upper airway obstruction

    Special attention should be paid by the technicians to obtain maximal and repeatable PEFs and forced inspiratory manoeuvres if there is a clinical or spirometric reason to suspect upper airway obstruction
    Be aware of how to distinguish intrathoracic from extrathoracic airway obstruction (table 10)
    Confirm the presence of central and upper airway obstruction with imaging and/or endoscopic techniques
    • PEF: peak expiratory flow.

  • Table. 12—

    Reported significant changes in forced vital capacity(FVC), forced expiratory volume in one second (FEV1), mid-expiratory flow (MEF25–75%) and carbon monoxide diffusing capacity (DL,CO) over time

    FVCFEV1MEF25–75%DL,CO
    Within a day
     Normal subjects≥5≥5≥13>7%
     COPD patients≥11≥13≥23
    Week to week
     Normal subjects≥11≥12≥21>6 units
     COPD patients≥20≥20≥30>4 units
    Year to year≥15≥15>10%
    • The variables are the same as in tables 6⇑ and 8⇑. Results for spirometry are rounded to the nearest integer 25, 128. The within-day DL,CO variability is from a study of diurnal variation in healthy nonsmokers 133. The week-to-week coefficient of repeatability (CR) is given for DL,CO in units of mL·min−1·mmHg−1, as calculated from CRs originally stated in units of mmol·min−1·kPa−1 138. The year-to-year variability of healthy adults is given using a 95% confidence interval 139. CRs from repeatability testing performed in your own laboratory should be substituted for the values in this table. COPD: chronic obstructive pulmonary disease.

  • Table. 13—

    Summary of the considerations for the interpretation of change in lung function

    Be aware of possible significant changes in lung function parameters over time (table 12)
    Multiple measurements over time are more likely to signal a real change in lung function than two measurements
    When too many indices of lung function are tracked simultaneously, the risk of false-positive indications of change increases
    Clinical interpretation of serial tests should not be based solely on the coefficient of repeatability, but also on the clinical findings
  • Table. 14—

    Degree of severity of decrease in diffusing capacity for carbon monoxide(DL,CO)

    Degree of severityDL,CO % pred
    Mild>60% and <LLN
    Moderate40–60%
    Severe<40
    • % pred: % predicted; LLN: lower limits of normal.

  • Table. 15—

    Summary of the considerations for diffusing capacity for carbon monoxide(DL,CO) interpretation

    Refer to a scheme to grade the severity of reductions in DL,CO (table 14)
    Interpreting DL,CO in conjunction with spirometry and lung volumes may assist in diagnosing the underlying disease (fig. 2)
    Adjustments of DL,CO for changes in haemoglobin and carboxyhaemoglobin are important
    The relationship between DL,CO and lung volume is not linear, so DL,CO/VA or DL,CO/TLC do not provide an appropriate way to normalise DL,CO for lung volume
    Nonlinear adjustments may be considered, but their clinical utility must be established before they can be recommended
    • VA: alveolar volume; TLC: total lung capacity.

  • Table. 16—

    List of abbreviations and meanings

    ATPDAmbient temperature, ambient pressure, and dry
    ATPSAmbient temperature and pressure saturated with water vapour
    BTPSBody temperature (i.e. 37°C), ambient pressure, saturated with water vapour
    CCentigrade
    CFCChlorofluorocarbons
    cmCentimetres
    COHbCarboxyhaemoglobin
    DL,CODiffusing capacity for the lungs measured using carbon monoxide, also known as transfer factor
    DL,CO/VADiffusing capacity for carbon monoxide per unit of alveolar volume, also known as KCO
    DMMembrane-diffusing capacity
    DTDwell time of flow >90% of PEF
    EFLExpiratory flow limitation
    ERVExpiratory reserve volume
    EVBack extrapolated volume
    EVCExpiratory vital capacity
    FA,XFraction of gas X in the alveolar gas
    FA,X,tAlveolar fraction of gas X at time t
    FEF25–75%Mean forced expiratory flow between 25% and 75% of FVC
    FEFX%Instantaneous forced expiratory flow when X% of the FVC has been expired
    FEV1Forced expiratory volume in one second
    FEVtForced expiratory volume in t seconds
    FE,XFraction of expired gas X
    FIFX%Instantaneous forced inspiratory flow at the point where X% of the FVC has been inspired
    FI,XFraction of inspired gas X
    FIVCForced inspiratory vital capacity
    FRCFunctional residual capacity
    FVCForced vital capacity
    H2OWater
    HbHaemoglobin
    HgMercury
    HzHertz; cycles per second
    ICInspiratory capacity
    IRVInspiratory reserve volume
    IVCInspiratory vital capacity
    KCOTransfer coefficient of the lung (i.e. DL,CO/VA)
    kgKilograms
    kPaKilopascals
    LLitres
    L·min−1Litres per minute
    L·s−1Litres per second
    lbPounds
    MEFX%Maximal instantaneous forced expiratory flow where X% of the FVC remains to be expired
    MFVLMaximum flow–volume loop
    mgMilligrams
    MIFMaximal inspiratory flow
    mLMillilitres
    mmMillimetres
    MMEFMaximum mid-expiratory flow
    msMilliseconds
    MVVMaximum voluntary ventilation
    PA,O2Alveolar oxygen partial pressure
    PBBarometric pressure
    PEFPeak expiratory flow
    PH2OWater vapour partial pressure
    PI,O2Inspired oxygen partial pressure
    θ (theta)Specific uptake of CO by the blood
    RTRise time from 10% to 90% of PEF
    RVResidual volume
    sSeconds
    STPDStandard temperature (273 K, 0°C), pressure (101.3 kPa, 760 mmHg) and dry
    TBTuberculosis
    TGV (or VTG)Thoracic gas volume
    tITime taken for inspiration
    TLCTotal lung capacity
    TrTracer gas
    ttotTotal time of respiratory cycle
    TV (or VT)Tidal volume
    VAAlveolar volume
    VA,effEffective alveolar volume
    VCVital capacity
    VcPulmonary capillary blood volume
    VDDead space volume
    VIInspired volume
    VSVolume of the expired sample gas
    µgMicrograms
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Interpretative strategies for lung function tests
R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, F. Burgos, R. Casaburi, A. Coates, C. P. M. van der Grinten, P. Gustafsson, J. Hankinson, R. Jensen, D. C. Johnson, N. MacIntyre, R. McKay, M. R. Miller, D. Navajas, O. F. Pedersen, J. Wanger
European Respiratory Journal Nov 2005, 26 (5) 948-968; DOI: 10.1183/09031936.05.00035205

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Interpretative strategies for lung function tests
R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, F. Burgos, R. Casaburi, A. Coates, C. P. M. van der Grinten, P. Gustafsson, J. Hankinson, R. Jensen, D. C. Johnson, N. MacIntyre, R. McKay, M. R. Miller, D. Navajas, O. F. Pedersen, J. Wanger
European Respiratory Journal Nov 2005, 26 (5) 948-968; DOI: 10.1183/09031936.05.00035205
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  • Article
    • BACKGROUND
    • REFERENCE EQUATIONS
    • TYPES OF VENTILATORY DEFECTS
    • COMMENTS ON INTERPRETATION AND PATTERNS OF DYSFUNCTION
    • SEVERITY CLASSIFICATION
    • BRONCHODILATOR RESPONSE
    • CENTRAL AND UPPER AIRWAY OBSTRUCTION
    • INTERPRETATION OF CHANGE IN LUNG FUNCTION
    • DL,CO INTERPRETATION
    • ABBREVIATIONS
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
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