Abstract
The concept of measuring expired lung volumes to assess lung function has existed since the late seventeenth century. Spirometry in its current form is a versatile and informative assessment of pulmonary ventilation that does not require highly specialised equipment, making it the most common and accessible lung function test.
Although spirometry is effort-dependent and can be a physically demanding test (particularly for patients with severe lung disease), the majority of individuals can achieve technically acceptable and repeatable results with the correct coaching from appropriately trained operators. In isolation, spirometry cannot diagnose specific pathology (with the exception of asthma), but, instead, it can identify patterns of ventilatory impairment. However, it remains the mainstay of physiological assessment and a primary outcome for disease management and clinical trials.
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Selected References
Anderson SD, Brannan J, Spring J, et al. A new method for bronchial-provocation testing in asthmatic subjects using a dry powder of mannitol. Am J Respir Crit Care Med. 1997;156(3 Pt 1):758–65.
British Thoracic Society & Association for Respiratory Technology and Physiology. Guidelines for the measurement of respiratory function. Respir Med. 1994;88:165–94.
Clay RD, Iyer VN, Reddy DR, Siontis B, Scanlon PD. The “complex restrictive” pulmonary function pattern: clinical and radiologic analysis of a common but previously undescribed restrictive pattern. Chest. 2017;152:1258–65.
Cooper BG. Spirometry standards and FEV1/FVC repeatability. Prim Care Respir J. 2010;19:292–4.
Cooper BG. An update on contraindications for lung function testing. Thorax. 2011;66:714–23.
Cooper BG, Hunt JH, Kendrick AH, et al. ARTP practical handbook of spirometry. 3rd ed. London: Association for Respiratory Technology and Physiology; 2017. ISBN: 0-9536898-6-7
Cotes JE, Chinn DJ, Miller MR. Lung function. 6th ed. Malden, MA: Blackwell Publishing; 2006. ISBN: 0632064935
Dilektasli AG, Porszasz J, Casaburi R, et al. A novel spirometric measure identifies mild COPD unidentified by standard criteria. Chest. 2016;150(5):1080–90.
Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977;1:1645–8.
Gardner ZE, Ruppel GL, Kaminsky DA. Grading the severity of obstruction in mixed obstructive-restrictive lung disease. Chest. 2011;140:598–603.
Hansen JE, Sun XG, Adame D, Wasserman K. Argument for changing criteria for bronchodilator responsiveness. Respir Med. 2008;102:1777–83.
Hughes JMB, Pride NB. Lung function tests: physiological principle and clinical applications. London: Bailliere Tindall; 1999. ISBN: 0702023507
Kendrick AH, Johns DP, Leeming JP. Infection control of lung function equipment: a practical approach. Respir Med. 2003;97:1163–79.
Laszlo G. Pulmonary function: a guide for clinicians. New York: Cambridge University Press; 1994. ISBN: 0521446791
Mannino DM, Diaz-Guzman E. Interpreting lung function using 80% predicted and fixed thresholds identifies patients at increased risk of mortality. Chest. 2012;141:73–80.
Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.
Miller MR, Hankinson J, Brusasko V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.
Miller MR, Quanjer PH, Swanney PM, et al. Interpreting lung function data using 80% predicted and fixed thresholds misclassifies more than 20% of patients. Chest. 2011;139:52–9.
Miller MR. Does the use of per cent predicted have any evidence base? Eur Respir J. 2015;45(2):322–3.
Morris ZQ, Coz A, Starosta D. An isolated reduction of the FEV3/FVC ratio is an indicator of mild lung injury. Chest. 2013;144(4):1117–23.
Pellegrino R, Viegi G, Brusasco V, et al. Interpretive strategies for lung function tests. Eur Respir J. 2005;26:948–68.
Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95 year age range: the global lung function 2012 equations. Eur Respir J. 2012;40(6):1324–43.
Quanjer PH, Brazzale DJ, Boros PW, et al. Implications of adopting the Global Lungs Initiative 2012 all-age reference equations for spirometry. Eur Respir J. 2013;42(4):1046–54.
Quanjer PH, Pretto JJ, Brazzale DJ, et al. Grading the severity of airflow obstruction: new wine in old bottles. Eur Respir J. 2014;43(2):505–12.
Quanjer PH, Cooper B, Ruppel GL, et al. Defining airflow obstruction. Eur Respir J. 2015;45:561–2.
Schilder DP, Roberts A, Fry DL. Effect of gas density and viscosity on the maximal expiratory flow-volume relationship. J Clin Invest. 1963;42(11):1705–13.
Seed L, Wilson D, Coates AL. Children should not be treated like little adults in the PFT lab. Respir Care. 2012;57:61–74.
Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;195:557–82.
Ward H, Cooper BG, Miller MR. Improved criterion for assessing lung function reversibility. Chest. 2015;148(4):877–86.
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Stockley, J.A., Cooper, B.G. (2018). Breathing Out: Forced Exhalation, Airflow Limitation. In: Kaminsky, D., Irvin, C. (eds) Pulmonary Function Testing. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-94159-2_6
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