Abstract
Background Appropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiologic determinants of test results into functional classifications, and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standard for PFT interpretation.
Methods This technical standards document was developed by an international joint task force, appointed by the European Respiratory Society and the American Thoracic Society with multidisciplinary expertise in conducting and interpreting pulmonary function tests, and developing international standards. A comprehensive literature review was conducted, and published evidence was reviewed.
Results Recommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results, respectively are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments.
Conclusions PFTs interpretation must be complemented with clinical expertise and consider the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Sanja Stanojevic reports grants, support for travel from European Respiratory Society and was the Co-Chair of the Global Lung Function Initiative for ERS. Additionally, acted on the Pulmonary Function Testing Proficiency committee for the American Thoracic Society, all outside the submitted work.
Conflict of interest: David Kaminsky reports speaker fees from MGC Diagnostics, Inc. and honoraria from UpToDate, Inc., outside the submitted work.
Conflict of interest: Martin Miller has nothing to disclose.
Conflict of interest: Bruce Thompson reports grants from NHMRC; consulting fees from 4D Medical, Chiesi; lecture honoraria from 4D Medical, Chiesi, Mundipharma; and reports past academic work with the Global Lung Function Initiative for European Respiratory Society; outside the submitted work.
Conflict of interest: Andrea Aliverti reports patents on Forced Oscillation Technique from Philips and patents on Opto-Electronic Plethysmography from BTS Bioengineering, outside the submitted work.
Conflict of interest: Igor Barjaktarevic has nothing to disclose.
Conflict of interest: Brendan Cooper acted as Co-Chair of Global Lung Function Initiative at the European Respiratory Society, outside the submitted work.
Conflict of interest: Bruce Culver has nothing to disclose.
Conflict of interest: Eric Derom has nothing to disclose.
Conflict of interest: Graham Hall was former Co-Chair of Global Lung Function Initiative and reports previous academic and leadership work with the Global Lung Function Initiative, both with the European Respiratory Society, outside the submitted work.
Conflict of interest: Teal Hallstrand reports research grants from the NIH (NHLBI, NIAID), outside the submitted work.
Conflict of interest: Jörg D. Leuppi reports grants from the Swiss National Science Foundation (SNF 160072 and 185592) as well as by Swiss Personalised Health Network (SPHN 2018DR108). JDL has also received unrestricted grants from AstraZeneca AG Switzerland, Boehringer Ingelheim GmbH Switzerland, GSK AG Switzerland and Novartis AG Switzerland, outside the submitted work.
Conflict of interest: Neil MacIntyre reports consulting fees from Vyaire, outside the submitted work.
Conflict of interest: Meredith McCormack reports royalties for authorship for PFT chapters from UpToDate; consulting fees related to PFT quality and reading from Aridis; outside the submitted work.
Conflict of interest: Margaret Rosenfeld has nothing to disclose.
Conflict of interest: Erik R. Swenson has nothing to disclose.
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- Received May 26, 2021.
- Accepted November 18, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
