Role Of Pulmonary Function Tests Research Articles

The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD.

Pulmonary function testing (PFT) has a long and rich history in the definition, diagnosis, and management of COPD. For decades, spirometry has been regarded as the standard for diagnosing COPD; however, numerous studies have shown that COPD symptoms, pathology, and associated poor outcomes can occur, despite normal spirometry. Diffusing capacity and imaging studies have called into question the need for spirometry to put the "O" (obstruction) in COPD. The role of exercise testing and the ability of PFTs to phenotype COPD are reviewed. Although PFTs play an important role in diagnosis, treatment decisions are primarily determined by symptom intensity and exacerbation history. Although a seminal study positioned FEV1 as the primary predictor of survival, numerous studies have shown that tests other than spirometry are superior predictors of mortality. In years past, using spirometry to screen for COPD was promulgated; however, this only seems appropriate for individuals who are symptomatic and at risk for developing COPD.

Role of pulmonary function tests and computed tomography volumetric quantitative analysis in assessment of idiopathic pulmonary fibrosis

Role of pulmonary function tests and computed tomography volumetric quantitative analysis in assessment of idiopathic pulmonary fibrosis

The Role of Pulmonary Function Testing and Lung Imaging in the Long-Term Follow-Up of Patients with COVID-19 Pneumonia

Background: Post-COVID-19 Interstitial Lung Disease (PC-ILD) is characterized by fibrotic-like signs at high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) abnormalities after SARS-CoV-2 infection. It is still not clear how frequent these tests should be performed to rule out long-term consequences of COVID-19 pneumonia. Objectives: The aims of our study were to evaluate the incidence and risk factors of PC-ILD and possibly to propose a long-term follow-up program. Method: One-hundred patients, hospitalized in our ward for moderate to critical COVID-19, underwent two follow-up visits at three and 15 months in which PFTs and HRCT were performed. Results: At the 15-month follow-up, 8% of patients showed residual radiological and functional signs consistent with PC-ILD. All but one of these patients had already demonstrated PFTs and HRCT alterations at first follow-up visit, and the last 1 patient showed worsening of lung function during follow-up. These findings highlight the negative predictive value of PFTs at 3-month follow-up for the development of PC-ILD. Aging, severity of COVID-19, and degree of pulmonary involvement during acute infection proved to be significant risk factors for developing PC-ILD. Conclusions: Our study highlights the importance of PFTs in the long-term follow-up of patients affected by moderate to critical COVID-19 pneumonia. Further studies are needed to confirm our hypothesis that HRCT should be performed only in patients with PFTs abnormalities.

Role of pulmonary function testing in inflammatory bowel diseases (Review).

Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory entities of the gastrointestinal system with an unclear etiology. Extra-intestinal manifestations beyond the involvement of the gastrointestinal tract can also occur. Several studies have investigated the alterations of pulmonary function tests (PFTs) in patients with IBD. To the best of our knowledge, the present review article is the first to summarize all the types of PFTs that have been performed in patients with IBD. Contradictory data exist regarding the association of PFT alterations with disease activity. PFT abnormalities can develop in individuals with IBD who have no clear clinical signs or radiological evidence, suggesting that PFTs may be useful in detecting latent respiratory involvement. The most prevalent finding in the PFTs of adults and children with IBD is an impairment in the diffusing capacity for carbon monoxide, although evidence on the other tests, particularly spirometric values, and their connection with disease activity is inconsistent.

Lung Function Predicts Outcome in Children With Obstructive Lung Disease After Hematopoietic Stem Cell Transplantation.

Obstructive lung disease (OLD) that develops after hematopoietic stem cell transplantation (HSCT) has a significant impact on morbidity and mortality. We investigated the role of pulmonary function tests (PFTs) in the prediction of prognosis of OLD in children who have undergone HSCT. We retrospectively reviewed 538 patients who underwent allogenic HSCT in the Department of Pediatrics, Seoul St. Mary's Hospital, South Korea, from April 2009 to July 2017. OLD was identified on PFTs or chest computed tomography scans obtained from 3 months after HSCT onwards. OLD developed after HSCT in 46 patients (28 male individuals, median age: 11.2 y). The group that developed OLD with an unfavorable prognosis (n=23) had a lower forced vital capacity (FVC) (% of predicted, 78.53±24.00 vs. 97.71±16.96, P=0.01), forced expiratory volume in 1 second (FEV1) (% of predicted, 52.54±31.77 vs. 84.44±18.59, P=0.00), FEV1/FVC (%, 59.28±18.68 vs. 79.94±9.77, P=0.00), and forced expiratory flow at 25% to 75% of forced vital capacity (FEF25-75) (% of predicted, 30.95±39.92 vs. 57.82±25.71, P=0.00) at diagnosis than the group that developed OLD with a favorable prognosis (n=23). The group that developed OLD with an unfavorable prognosis had significant reductions in FVC, FEV1, FEV1/FVC, and FEF25-75 at 2 years after diagnosis. Children who develop OLD with an unfavorable prognosis after HSCT already have poor lung function at the time of diagnosis. Additional treatment should be considered in patients who develop OLD after HSCT according to their PFTs at diagnosis.

The utility of pulmonary function testing in the preoperative risk stratification of patients undergoing transcatheter aortic valve replacement.

The role of pulmonary function testing (PFT) as a predictor of clinically relevant endpoints in transcatheter aortic valve replacement (TAVR) is unclear. To determine the utility of PFT in the preoperative risk stratification of patients undergoing TAVR. An evaluation of PFT (i.e., FEV1), arterial blood gases (i.e., PO2), the diagnosis of chronic obstructive lung disease (COPD) by the Global Initiative for COPD (GOLD), and the diagnosis of chronic lung disease (CLD) by the Society of Thoracic Surgeons (STS) was performed to determine whether a relationship exists among these parameters and clinically relevant outcomes, including all-cause 30-day and 1-year mortality. A total of 513 patients underwent TAVR between March 2013 and December 2016. Per STS criteria, 269/513 (52%) had CLD with a mean FEV1 of 55.4 ± 12%. Per GOLD criteria, 158/513 (30%) of patients had COPD with a mean FEV1/forced vital capacity of 61.8 ± 8.2%. The severity of CLD was affected by changes in ejection fraction, albumin, creatinine, and B-type natriuretic peptide levels (p = .009, p < .001, p < .001, and p < .001, respectively), whereas the severity of COPD was not affected by these same variables, (p = .302, .079, .137, and .102, respectively). An increased A-a gradient (p = .035), increased PCO2 (p = .016), and decreased PO2 (p = <.001) demonstrated increased risk of 30-day mortality. Neither classification (COPD or CLD), nor PFT changes, showed association with 30-day and 1-year mortality (p = NS). This study suggests that isolated abnormalities in spirometry are a poor indicator of clinically relevant outcomes in TAVR. When classified correctly, COPD does not predict clinically relevant postoperative outcomes.

Contribution of pulmonary function tests (PFTs) to the diagnosis and follow up of connective tissue diseases

Introduction: Connective Tissue Diseases (CTDs) are systemic autoimmune conditions characterized by frequent lung involvement. This usually takes the form of Interstitial Lung Disease (ILD), but Obstructive Lung Disease (OLD) and Pulmonary Artery Hypertension (PAH) can also occur. Lung involvement is often severe, representing the first cause of death in CTD. The aim of this study is to highlight the role of Pulmonary Function Tests (PFTs) in the diagnosis and follow up of CTD patients. Main body: Rheumatoid Arthritis (RA) showed mainly an ILD with a Usual Interstitial Pneumonia (UIP) pattern in High-Resolution Chest Tomography (HRCT). PFTs are able to highlight a RA-ILD before its clinical onset and to drive follow up of patients with Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO). In the course of Scleroderma Spectrum Disorders (SSDs) and Idiopathic Inflammatory Myopathies (IIMs), DLCO appears to be more sensitive than FVC in highlighting an ILD, but it can be compromised by the presence of PAH. A restrictive respiratory pattern can be present in IIMs and Systemic Lupus Erythematosus due to the inflammatory involvement of respiratory muscles, the presence of fatigue or diaphragm distress. Conclusions: The lung should be carefully studied during CTDs. PFTs can represent an important prognostic tool for diagnosis and follow up of RA-ILD, but, on their own, lack sufficient specificity or sensitivity to describe lung involvement in SSDs and IIMs. Several composite indexes potentially able to describe the evolution of lung damage and response to treatment in SSDs are under investigation. Considering the potential severity of these conditions, an HRCT jointly with PFTs should be performed in all new diagnoses of SSDs and IIMs. Moreover, follow up PFTs should be interpreted in the light of the risk factor for respiratory disease related to each disease.

A normal diffusing capacity of the lungs for carbon monoxide is rare in incidental pulmonary arterial hypertension in systemic sclerosis: Data from the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma cohort.

Our purpose was to determine the frequency of normal diffusing capacity for carbon monoxide defined as ⩾70% predicted, in those diagnosed with pulmonary arterial hypertension in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma cohort. We compared those with normal diffusing capacity for carbon monoxide to those with reduced diffusing capacity for carbon monoxide <70% in order to better clarify the role of pulmonary function testing as a screening test for pulmonary arterial hypertension and to better understand this population. Entry criteria included a right heart catheterization with mean pulmonary artery pressure ⩾25 mm Hg and pulmonary capillary wedge pressure ⩽15 mm Hg. Demographics, echocardiogram variables, B-type natriuretic peptide levels, right heart catheterization findings, and survival were described for both groups. Of (n = 202), 11 (5.4%) had a diffusing capacity for carbon monoxide of ⩾70% versus 191 (94.6%) who had a diffusing capacity for carbon monoxide <70%. There were no identified statistical differences between the groups. Left atrium size was 4.1 cm in the normal diffusing capacity for carbon monoxide patients compared to 3.7 cm in the low diffusing capacity for carbon monoxide group but did not reach statistical significance. There were no statistically significant differences in survival. On repeat testing, seven patients subsequently developed a diffusing capacity for carbon monoxide <70%. Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma data suggest that it is very rare for a patient to develop pulmonary arterial hypertension with a preserved diffusing capacity for carbon monoxide. The data support the importance of obtaining diffusing capacity for carbon monoxide and that a patient with a normal diffusing capacity for carbon monoxide while suspected to have systemic sclerosis-pulmonary arterial hypertension should be considered critically. Diffusing capacity for carbon monoxide >70% was present in too few patients to find significant differences in B-type natriuretic peptide and atrium size. Future research should seek to confirm abnormal B-type natriuretic peptide, increased left atrium size, and other evidence of myocardial involvement on diffusing capacity for carbon monoxide.

Role of Pulmonary Function Tests in the Assessment of Lung Impairment in Patients with Diffuse Parenchymal Lung Diseases: Association with ClinicoradiologicalHistopathological Profile

Role of Pulmonary Function Tests in the Assessment of Lung Impairment in Patients with Diffuse Parenchymal Lung Diseases: Association with ClinicoradiologicalHistopathological Profile

A role of pulmonary function testing for detecting ventilation and gas exchange disorders in multilobar community-acquired pneumonia convalescents

The aim of this study was to analyze lung function in multilobar community-acquired pneumonia (CAP) convalescents. Methods. Spirometry, body plethysmography, and lung diffusing capacity were measured according to the joint European Respiratory Society and American Thoracic Society standards (2005). The carbon monoxide lung diffusing capacity was evaluated using a single breath-hold technique and was adjusted for hemoglobin. Results . The complete clinical and radiological resolution of CAP did not accompanied by recovery of lung function in all cases. Obstructive ventilation disorders were diagnosed in 18.2% of patients, restrictive ventilation disorders were diagnosed in 12.1% of patients, and gas exchange abnormalities were diagnosed in 51.5% of the patients. Conclusion. Lung function and gas exchange testing is an important marker of the patient's convalescence after CAP and duration of the recovery; it also could predict the need in subsequent follow-up.

Women with TSC: Relationship between Clinical, Lung Function and Radiological Features in a Genotyped Population Investigated for Lymphangioleiomyomatosis.

The advent of pharmacological therapies for lymphangioleiomyomatosis (LAM) has made early diagnosis important in women with tuberous sclerosis complex (TSC), although the lifelong cumulative radiation exposure caused by chest computer tomography (CT) should not be underestimated. We retrospectively investigated, in a cohort of TSC outpatients of San Paolo Hospital (Milan, Italy) 1) the role of pulmonary function tests (PFTs) for LAM diagnosis, 2) the association between LAM and other features of TSC (e.g. demography, extrapulmonary manifestations, genetic mutations, etc.), and 3) the characteristics of patients with multifocal micronodular pneumocyte hyperplasia (MMPH). Eighty-six women underwent chest CT scan; pulmonary involvement was found in 66 patients (77%; 49% LAM with or without MMPH, and 28% MMPH alone). LAM patients were older, with a higher rate of pneumothorax, presented more frequently with renal and hepatic angiomyolipomas, and tended to have a TSC2 mutation profile. PFTs, assessed in 64% of women unaffected by cognitive impairments, revealed a lower lung diffusion capacity in LAM patients. In multivariate analysis, age, but not PFTs, resulted independently associated with LAM diagnosis. Patients with MMPH alone did not show specific clinical, functional or genetic features. A mild respiratory impairment was most common in LAM-TSC patients: In conclusions, PFTs, even if indicated to assess impairment in lung function, are feasible in a limited number of patients, and are not significantly useful for LAM diagnosis in women with TSC.

What Is the Role of Pulmonary Function Tests in the Diagnosis and the Monitoring of the Interstitial Lung Disease?

What Is the Role of Pulmonary Function Tests in the Diagnosis and the Monitoring of the Interstitial Lung Disease?

Role of pulmonary function tests in screening pulmonary arterial hypertension in scleroderma

Pulmonary arterial hypertension (PAH) is a life-threatening complication of scleroderma. Its prevalence is estimated to be between 12 and 29%. The symptoms are usually nonspecific and overlooked in those patients already limited by other complications of their condition. It is recommended to perform noninvasive screening for scleroderma patients for early detection of PAH, which has a significant impact on treatment strategy and clinical outcomes. The aim of this study was to assess the role of certain pulmonary function parameters [forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), FVC/DLCO] in the early prediction of PAH in scleroderma patients. This prospective study was conducted on 30 scleroderma-diagnosed patients; all patients were subjected to routine laboratory investigations, plain chest radiographic posteroanterior view, computed tomography of the chest, transthoracic echocardiography, spirometry, and DLCO. The echocardiographic results showed pulmonary artery systolic pressure greater than 35 mmHg in eight patients, which led to suspect a possibility of pulmonary hypertension (PH) in those patients. On comparing patients with suspected PH and others, we found significant differences in the values of FVC% and DLCO%, which was significantly lower in patients with suspected PH (P < 0.05), and FVC%/DLCO% was significantly higher in those patients (P < 0.05). The best cutoff value of FVC/DLCO for predicting suspected PH among the studied cases was a value greater than 1.91, with a sensitivity of 87.5% and a specificity of 100%. Assessment of pulmonary functions is an easy and helpful tool in screening pulmonary vasculopathy in scleroderma patients. It helps to suspect patients with early PH, which can be subsequently confirmed with further appropriate tests. Egypt J Broncho 2015 9:287–292

Supplemental oxygen therapy in bleomycin-induced pulmonary toxicity: REPLY

At the outset, on behalf of all the authors, I thank the reader for having shown keen interest in the article entitled “Reversible Bleomycin Toxicity” published in the July issue of MJAFI.1 The reader has brought out clinically relevant and important issues pertaining to exacerbation/precipitation of bleomycin-induced pulmonary toxicity caused by supplemental oxygen administration particularly in the context of general anaesthesia. As mentioned in our article, exposure to high-dose oxygen is one of the several important risk factors known for development of bleomycin pulmonary toxicity. We did not go into the details of the risk factors of bleomycin toxicity as our article focused mainly on the unusual HRCT features of bleomycin toxicity and imaging (HRCT) demonstration of reversibility of the lesions. I agree with the comments of the reader concerned with regard to the potentially serious synergistic effects of supplemental oxygen therapy in a patient with prior exposure to bleomycin. Exposure to bleomycin appears to sensitise the lungs and potentially fatal acute lung damage can occur at an inspired oxygen concentration which is otherwise considered normal for a healthy individual. However, this issue is debatable.2, 3 Nevertheless, it may be clinically relevant as many of the patients who receive bleomycin therapy for a variety of disorders are relatively young and may subsequently undergo surgery where general anaesthesia would be considered. Awareness and knowledge of these risk factors would certainly prove invaluable in preventing/avoiding perioperative complications in a patient with prior exposure to bleomycin. At this point, I would like to mention that the issue of perioperative reduction of oxygen in patients with prior exposure to bleomycin is also debatable.4, 5 There are conflicting reports regarding the role of pulmonary function tests and carbon monoxide diffusing capacity (DLco) as an indicator of bleomycin-induced pulmonary toxicity.6, 7 However, the general consensus is that DLco has an important role in this regard. As enquired by the reader, I would like to inform here that our patient did not receive any supplemental oxygen therapy after the administration of bleomycin. At the last review, which was approximately six months after stoppage of bleomycin, the individual was asymptomatic, a repeat pulmonary function test was normal. Repeat DLco test was done and was normal. After going through the existing literature and the pertinent comments of the reader, I think, it may be worthwhile to document in the medical records as well as personal health card and also brief the patient/care taker concerned on the recent exposure to bleomycin and possible potential complications if need arises for supplemental oxygen therapy or general anaesthesia for any reason in future. This may be particularly relevant for the Armed Forces population who move from place to place.

The Role of Pulmonary Function Testing in Infants

Tests of pulmonary function are used routinely in school-age and older children to augment or confirm clinical findings obtained by a careful history and physical examination. Spirometry allows both detection of airway obstruction even before wheezing can be heard and objective assessment of medical interventions. Measurement of lung volumes separates those processes that cause restriction from those that do not affect lung size or those that cause air trapping. Serial measurements have yielded important insights into the normal growth and aging of the lung as well as showing how various diseases affect lung and airway growth and repair. Although techniques to measure lung function in infants and toddlers have been available for more than 40 years, they have not been used clinically to the same degree that pulmonary function testing has been used in older children and adults. Possible reasons for infant pulmonary function testing not to be performed routinely relate both to the testing conditions and to the information gained. Chief among the former is the need to sedate all but the youngest infants to perform many of these studies. Both parents (1) and physicians (2) express concern over the need to sedate sick infants, even though the sedation typically is tolerated well. Some tests, such as respiratory inductive plethysmography or the forced oscillation technique, do not require sedation of the infant. Other procedural barriers include what must be done to the infant to obtain the necessary information. For example, measurements of dynamic pulmonary compliance and resistance require placement of an esophageal balloon or catheter and, therefore, are considered invasive. Forced expiratory flows by the rapid thoracic compression (“squeeze”) technique may appear uncomfortable for the infant, although infants do not demonstrate any physiologic signs of distress or discomfort during the testing. Some parents have expressed negative feelings after …

The role of pulmonary function testing in pulmonary fibrosis.

Interstitial lung diseases are characterized by disruption of the distal pulmonary parenchyma. The clinical history manifestations, cough and dyspnea, and physical exam manifestations, inspiratory crackles, are nonspecific. Pulmonary function testing aids in the evaluation and management of patients with interstitial lung disease although the pattern of abnormality is nonspecific. Pulmonary function testing can provide an estimate of histologic severity but not a definitive quantification of histologic fibrosis or inflammation. Pulmonary function tests can provide a baseline estimation of prognosis and be used to monitor disease progression or response to therapy. The forced vital capacity and diffusion capacity are the most valuable serial measurements, but further data are required to examine composite scoring and exercise gas exchange.

Clinical non-invasive measurement of effective pulmonary capillary blood flow.

Since traditional pulmonary function testing is centered on measurements of air flow and lung volume, a method to assess the pulmonary circulation might improve our ability to evaluate diseases that impact upon pulmonary hemodynamics. We have developed a PC based application that rapidly calculates pulmonary blood flow. Subjects rebreath a mixture of 10% argon and 3.5% freon for 20 seconds. Gas concentrations at the mouth are monitored by a clinical mass spectrometer and signals are acquired and processed with off-the-shelf hardware. To test the accuracy and reproducibility of this technique, patients with pulmonary artery catheters were assessed by standard thermodilution methods and the rebreathing test. Measurements using this non-invasive technology closely corelate with invasive thermodilution methods (r = 0.980) and show equivalent reproducibility (average standard error = 2.5%). This application of signal processing technology can extend the role of pulmonary function testing to include routine evaluation of the pulmonary circulation.

Bleomycin-Induced Pulmonary Toxicity

Bleomycin is recognized to cause an interstitial pneumonitis that can lead to fibrosis. Although its occurrence may be sporadic, some factors may increase the risk of such a pulmonary reaction. In this article the clinical setting and presentation, radiographic manifestations, pathologic findings, and the prognosis of bleomycin-induced interstitial fibrosis are described. Additionally, the role of pulmonary function tests in monitoring patients for toxicity is discussed.

Role of Pulmonary Function Tests in the Prevention of Bleomycin Pulmonary Toxicity During Chemotherapy for Metastatic Testicular Teratoma

Thirty-eight men were treated for metastatic teratoma with up to four courses of chemotherapy, each containing 90 mg bleomycin. Routine pulmonary function tests (PFTs) were performed before each course to assess their value in detecting bleomycin pulmonary toxicity. PFTs were repeated 2-5 yr after completion of chemotherapy in 10 disease-free survivors. Analysis of changes in individual PFT values showed a fall in the carbon monoxide diffusing capacity (DLco) after 90 mg bleomycin (P less than 0.005). The DLco remained depressed with subsequent doses of bleomycin, but there was no further statistically significant fall. There was no significant change in any other PFT. Similarly, late PFT values showed no significant change. There was no correlation between changes in the visible extent of metastases as assessed from the chest radiography and changes in serial PFTs. It is concluded that routine PFTs are unnecessary if the total bleomycin dose in less than or equal to 360 mg, unless there are particular risk factors. Late drug-induced pulmonary damage is unlikely to develop after treatment withdrawal.

Role of pulmonary function tests in the prevention of bleomycin pulmonary toxicity during chemotherapy for metastatic testicular teratoma

Thirty-eight men were treated for metastatic testicular teratoma with up to four courses of chemotherapy, each containing 90 mg bleomycin. Routine pulmonary function tests (PFTs) were performed before each course to assess their value in detecting bleomycin pulmonary toxicity. PFTs were repeated 2–5 yr after completion of chemotherapy in 10 disease-free survivors. Analysis of changes in individual PFT values showed a fall in the carbon monoxide diffusing capacity (DL CO) after 90 mg bleomycin ( P < 0.005). The DL CO remained depressed with subsequent doses of bleomycin, but there was no further statistically significant fall. There was no significant change in any other PFT. Similarly, late PFT values showed no significant change. There was no correlation between changes in the visible extent of metastases as assessed from the chest radiograph and changes in serial PFTs. It is concluded that routine PFTs are unnecessary if the total bleomycin dose is ≤ 360 mg, unless there are particular risk factors. Late drug-induced pulmonary damage is unlikely to develop after treatment withdrawal.