Interpretation Of Pulmonary Function Tests.doc
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Interpretation Of Pulmonary Function Tests.doc
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How to Interpret Pulmonary Function Tests: A Stepwise Approach
Pulmonary function tests (PFTs) are a group of tests that measure how well your lungs work. They can help diagnose and monitor lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis. PFTs can also assess the effect of treatment or medication on your lung function.
There are different types of PFTs, but the most common ones are spirometry, lung volumes, and diffusion capacity. Spirometry measures how much air you can breathe in and out, and how fast you can do it. Lung volumes measure how much air is in your lungs at different stages of breathing. Diffusion capacity measures how well your lungs transfer oxygen and carbon dioxide between the air and your blood.
Before PFT results can be reliably interpreted, three factors must be confirmed: (1) the volume-time curve reaches a plateau, and expiration lasts at least six seconds; (2) results of at least three acceptable spirograms are consistent; and (3) the flow-volume loops are free of artifacts and abnormalities[^1^].
The interpretation of PFTs involves comparing the measured values with the predicted values based on age, sex, height, and race. The predicted values are usually given as a percentage of normal. A value below 80% of normal is considered abnormal.
The interpretation of PFTs also involves identifying patterns of lung dysfunction, such as obstructive, restrictive, or mixed. Obstructive lung diseases are characterized by reduced airflow due to narrowing or blockage of the airways. Examples of obstructive lung diseases are asthma, COPD, and bronchiectasis. Restrictive lung diseases are characterized by reduced lung volumes due to stiffening or scarring of the lung tissue or chest wall. Examples of restrictive lung diseases are pulmonary fibrosis, sarcoidosis, and neuromuscular disorders. Mixed lung diseases are characterized by both reduced airflow and reduced lung volumes. Examples of mixed lung diseases are cystic fibrosis, obesity hypoventilation syndrome, and overlap syndrome.
A stepwise approach to the interpretation of PFTs can help clinicians to identify the type and severity of lung dysfunction, as well as the possible causes and implications for treatment. The following steps are suggested:
Look at the spirometry results and calculate the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). If the FEV1/FVC ratio is less than 0.7, there is an obstructive pattern. If the FEV1/FVC ratio is normal or high, there is no obstruction.
Look at the FEV1 value and compare it with the predicted value. If the FEV1 is less than 80% of predicted, there is an impairment of airflow. The degree of impairment can be classified as mild (FEV1 60% to 79% of predicted), moderate (FEV1 40% to 59% of predicted), severe (FEV1 25% to 39% of predicted), or very severe (FEV1 less than 25% of predicted).
Look at the FVC value and compare it with the predicted value. If the FVC is less than 80% of predicted, there is a reduction in lung volume. The degree of reduction can be classified as mild (FVC 60% to 79% of predicted), moderate (FVC 40% to 59% of predicted), severe (FVC 25% to 39% of predicted), or very severe (FVC less than 25% of predicted).
If there is no obstruction and no reduction in lung volume, the spirometry results are normal. If there is obstruction but no reduction in lung volume, there is an isolated obstructive pattern. If there is no obstruction but a reduction in lung volume, there is an isolated restrictive pattern. If there is both obstruction and a reduction in lung volume, there is a mixed pattern.
If there is an isolated obstructive pattern or a mixed pattern, look at the bronchodilator response test results. This test involves repeating spirometry
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