scholarly journals ERS/ATS technical standard on interpretive strategies for routine lung function tests

2021 ◽  
pp. 2101499
Author(s):  
Sanja Stanojevic ◽  
David A. Kaminsky ◽  
Martin Miller ◽  
Bruce Thompson ◽  
Andrea Aliverti ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
American Thoracic Society ◽  
International Standards ◽  
Healthy Population ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Function Tests ◽  
Published Evidence

BackgroundAppropriate 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.MethodsThis 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.ResultsRecommendations 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.ConclusionsPFTs 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.

scholarly journals Predicting Pulmonary Function Testing from Quantified Computed Tomography Using Machine Learning Algorithms in Patients with COPD

Diagnostics ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 33 ◽  
Author(s):  
Joshua Gawlitza ◽  
Timo Sturm ◽  
Kai Spohrer ◽  
Thomas Henzler ◽  
Ibrahim Akin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Computed Tomography ◽  
Lung Function ◽  
Pulmonary Function ◽  
Polynomial Regression ◽  
Pulmonary Function Tests ◽  
Quantitative Computed Tomography ◽  
Machine Learning Algorithms ◽  
Gradient Boosting ◽  
Function Tests

Introduction: Quantitative computed tomography (qCT) is an emergent technique for diagnostics and research in patients with chronic obstructive pulmonary disease (COPD). qCT parameters demonstrate a correlation with pulmonary function tests and symptoms. However, qCT only provides anatomical, not functional, information. We evaluated five distinct, partial-machine learning-based mathematical models to predict lung function parameters from qCT values in comparison with pulmonary function tests. Methods: 75 patients with diagnosed COPD underwent body plethysmography and a dose-optimized qCT examination on a third-generation, dual-source CT with inspiration and expiration. Delta values (inspiration—expiration) were calculated afterwards. Four parameters were quantified: mean lung density, lung volume low-attenuated volume, and full width at half maximum. Five models were evaluated for best prediction: average prediction, median prediction, k-nearest neighbours (kNN), gradient boosting, and multilayer perceptron. Results: The lowest mean relative error (MRE) was calculated for the kNN model with 16%. Similar low MREs were found for polynomial regression as well as gradient boosting-based prediction. Other models led to higher MREs and thereby worse predictive performance. Beyond the sole MRE, distinct differences in prediction performance, dependent on the initial dataset (expiration, inspiration, delta), were found. Conclusion: Different, partially machine learning-based models allow the prediction of lung function values from static qCT parameters within a reasonable margin of error. Therefore, qCT parameters may contain more information than we currently utilize and can potentially augment standard functional lung testing.

scholarly journals Executive Summary: 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung

2017 ◽  
Vol 49 (1) ◽  
pp. 16E0016 ◽  
Author(s):  
Brian L. Graham ◽  
Vito Brusasco ◽  
Felip Burgos ◽  
Brendan G. Cooper ◽  
Robert Jensen ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Lung Function ◽  
American Thoracic Society ◽  
Common Type ◽  
Tracer Gas ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Executive Summary ◽  
Link Type ◽  
Single Breath

This document summarises an update to the European Respiratory Society (ERS)/American Thoracic Society (ATS) technical standards for single-breath carbon monoxide uptake in the lung that was last updated in 2005. The full standards are also available online as https://doi.org/10.1183/13993003.00016-2016. The major changes in these technical standards relate to DLCO measurement with systems using rapidly responding gas analysers for carbon monoxide and the tracer gas, which are now the most common type of DLCO instrumentation being manufactured. Technical improvements and the increased capability afforded by these new systems permit enhanced measurement of DLCO and the opportunity to include other optional measures of lung function.

scholarly journals Integrative genomic analysis in African American children with asthma finds 3 novel loci associated with lung function

2020 ◽  
Author(s):  
Pagé C. Goddard ◽  
Kevin L. Keys ◽  
Angel C.Y. Mak ◽  
Eunice Yujung Lee ◽  
Amy K. Liu ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Genome Wide Association Study ◽  
Mononuclear Cells ◽  
Pulmonary Function Tests ◽  
Genomic Analysis ◽  
Lung Fibroblasts ◽  
Admixture Mapping ◽  
Function Tests ◽  
Genes And Environment

AbstractBronchodilator drugs are commonly prescribed for treatment and management of obstructive lung function present with diseases such as asthma. Administration of bronchodilator medication can partially or fully restore lung function as measured by pulmonary function tests. The genetics of baseline lung function measures taken prior to bronchodilator medication has been extensively studied, and the genetics of the bronchodilator response itself has received some attention. However, few studies have focused on the genetics of post-bronchodilator lung function. To address this gap, we analyzed lung function phenotypes in 1,103 subjects from the Study of African Americans, Asthma, Genes, and Environment (SAGE), a pediatric asthma case-control cohort, using an integrative genomic analysis approach that combined genotype, locus-specific genetic ancestry, and functional annotation information. We integrated genome-wide association study (GWAS) results with an admixture mapping scan of three pulmonary function tests (FEV1, FVC, and FEV1/FVC) taken before and after albuterol bronchodilator administration on the same subjects, yielding six traits. We identified 18 GWAS loci, and 5 additional loci from admixture mapping, spanning several known and novel lung function candidate genes. Most loci identified via admixture mapping exhibited wide variation in minor allele frequency across genotyped global populations. Functional fine-mapping revealed an enrichment of epigenetic annotations from peripheral blood mononuclear cells, fetal lung tissue, and lung fibroblasts. Our results point to three novel potential genetic drivers of pre- and post-bronchodilator lung function: ADAMTS1, RAD54B, and EGLN3.

Association between body composition and pulmonary function tests among health care workers in Iran

2021 ◽  
Vol 17 ◽  
Author(s):  
Hamidreza Pouragha ◽  
Hosein Kazemi ◽  
Gholamreza Pouryaghoub ◽  
Ramin Mehrdad
Keyword(s):  
Body Composition ◽  
Lung Function ◽  
Pulmonary Function ◽  
Visceral Fat ◽  
Pulmonary Function Tests ◽  
The Body ◽  
Fat Free Mass ◽  
The Other ◽  
Cross Sectional ◽  
Function Tests

Background: Why is bodyweight not a predictor of lung function, while height, sex, race, and age are predictors of lung capacity and function? In this study, we want to investigate the association between body composition and pulmonary function. And, as much as possible, answer the question of why bodyweight is not predictive of lung function. Methods: This cross-sectional study was performed among 2967 employees of Tehran University of Medical Sciences (TUMS) who participated in the TUMS Employees Cohort (TEC) study. The body composition of the participants was measured using the Bioelectrical Impedance Analysis (BIA) method. Anthropometric variables were also measured as a confounder. The pulmonary function of participants was assessed by a forced spirometry test. Results: The correlation of BIA values including fat-free mass and total body water with a pulmonary function such as FEV1, FVC, and FEF25-75 is higher than most anthropometric values such as weight, wrist circumference, and the waist to hip ratio. Also, in regression analysis, age and sex had an association with pulmonary function, but the weight did not show a significant relationship. On the other hand, fat-free mass and visceral fat were significantly associated with pulmonary function. One is direct and the other is inverse. Conclusion: We observed a negative association between visceral fat and pulmonary function tests and a direct association between Fat-free mass pulmonary function tests (FEV1 and FVC) adjusted for age, sex, and anthropometric indices.

Effect of triiodothyronine-induced thyrotoxicosis on airway hyperresponsiveness

1991 ◽  
Vol 71 (2) ◽  
pp. 438-444 ◽  
Author(s):  
H. M. Hollingsworth ◽  
M. R. Pratter ◽  
J. M. Dubois ◽  
L. E. Braverman ◽  
R. S. Irwin
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Exercise Capacity ◽  
Controlled Trial ◽  
Pulmonary Function Tests ◽  
Airway Responsiveness ◽  
Mild Asthma ◽  
Thyroid Function Tests ◽  
Double Blind ◽  
Function Tests

To determine whether thyrotoxicosis has an effect on the asthmatic state in subjects with mild asthma, airway responsiveness, lung function, and exercise capacity were measured in a randomized double-blind placebo-controlled trial before and after liothyronine (triiodothyronine, T3)-induced thyrotoxicosis. Baseline evaluation of 15 subjects with mild asthma included clinical evaluation, thyroid and routine pulmonary function tests, airway responsiveness assessment by methacholine inhalation challenge, and a symptom-limited maximal exercise test. For all subjects, the initial testing revealed that the dose of methacholine which provoked a 20% fall in forced expiratory volume in 1s (PD20) was in a range consistent with symptomatic asthma. There was no significant change in pulmonary function tests, airway reactivity (PD20), or exercise capacity in either the placebo or the T3-treated groups. Thyroid function tests confirmed mild sustained thyrotoxicosis in the T3-treated groups. We conclude that mild T3-induced thyrotoxicosis of 4-wk duration had no effect on lung function, airway responsiveness, or exercise capacity in subjects with mild asthma.

scholarly journals Dismantling airway disease with the use of new pulmonary function indices

2019 ◽  
Vol 28 (151) ◽  
pp. 180122 ◽  
Author(s):  
Sabine C. Zimmermann ◽  
Katrina O. Tonga ◽  
Cindy Thamrin
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Airway Disease ◽  
Pulmonary Mechanics ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Function Tests ◽  
Chronic Airway Disease ◽  
Chronic Airway

We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care.In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed.

Interpretation of pulmonary function tests: beyond the basics

2016 ◽  
Vol 65 (2) ◽  
pp. 301-310 ◽  
Author(s):  
Bashar S Staitieh ◽  
Octavian C Ioachimescu
Keyword(s):  
Pulmonary Function ◽  
Vital Capacity ◽  
Pulmonary Function Tests ◽  
Practical Method ◽  
Forced Expiratory Volume ◽  
European Respiratory Society ◽  
Prognostic Information ◽  
Lung Capacity ◽  
Function Tests ◽  
Functional Indices

Although the general framework described in the joint American Thoracic Society/European Respiratory Society guidelines provides a useful and practical method for the interpretation of pulmonary function tests, several other measurements and functional indices, if understood correctly, may help in diagnosis and management of patients with respiratory diseases and in design of research protocols. This review provides information on the underlying physiology, interpretative caveats, and the evidence supporting the use of a number of these indices. Some of these measurements, such as the inspiratory fraction, inspiratory capacity/total lung capacity (IC/TLC), may offer additional prognostic information, while others, such as residual volume (RV)/TLC and forced expiratory volume in 3 s/forced vital capacity (FEV3/FVC), may help fill in the gaps between patient symptoms and more traditional indices of pulmonary function. Although most studies of non-traditional indices focus on airflow-limiting disorders, many can be fruitfully applied in other settings. Understanding the physiology that catalyzed these investigations will undoubtedly enrich the functional assessment armamentarium of the practicing clinician and researcher.

scholarly journals Comparison of Per Cent Predicted and Percentile Values for Pulmonary Function Test Interpretation

2009 ◽  
Vol 16 (6) ◽  
pp. 189-193 ◽  
Author(s):  
Smita Pakhale ◽  
Zoheir Bshouty ◽  
Theodore K Marras
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Residual Volume ◽  
European Respiratory Society ◽  
Diffusion Capacity ◽  
Percentile Method ◽  
Lung Capacity ◽  
Test Characteristics ◽  
The Mean

BACKGROUND: Pulmonary function tests (PFTs) are commonly interpreted as a fraction of predicted normal values, with an abnormal test often defined as less than 80% or greater than 120% of the predicted value. However, recommendations of the American Thoracic Society/European Respiratory Society suggest using a percentile-based approach to define an abnormal test (less than the fifth or greater than the 95th percentiles).OBJECTIVE: To compare PFT values obtained by the per cent predicted method with the percentile-based method for lung function parameters.METHODS: Full PFTs performed between January 2000 and July 2004, at the Health Sciences Centre (Winnipeg, Manitoba) were analyzed. Using the Crapo and Gutierrez equations, per cent predicted and percentile values were calculated. An abnormal test was defined as less than 80% or greater than 120% of predicted (per cent predicted method) or as less than the fifth or greater than the 95th percentiles (percentile method). Using the percentile method as reference standard, the diagnostic test characteristics of the per cent predicted method were calculated.RESULTS: The full PFTs of 2176 men and 1658 women were analyzed using the Crapo and Gutierrez equations. The mean (± SD) age of all subjects was 52±15 years. Per cent agreement between the two tests was more than 94% for all parameters except for reduced residual volume (88%). Per cent predicted methods had suboptimal sensitivity for abnormal total lung capacity (88% to 89%), increased residual volume (83% to 89%) and reduced diffusion capacity (89% with Crapo equations). Suboptimal specificity (83% to 86%) was observed for decreased residual volume.CONCLUSION: The results of the per cent predicted and percentile-based approaches for PFT interpretation were similar for the majority of lung function parameters. These two methods can be used interchangeably for spirometry. However, caution may be warranted in relying solely on per cent predicted methods for assessing lung volume or diffusion capacity.

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