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The Utility of Spirometry in Diagnosing Pulmonary Restriction

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Abstract

The aim of this retrospective study was to determine the utility of the spirometric measurements FVC, FEV1, and FEV1/FVC in diagnosing pulmonary restriction. Spirometry and lung volume measurements performed on the same patient visit were analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (1) FVC < lower limit of normal (LLN) (NHANES III reference values) and (2) FVC < LLN and FEV1/FVC ≥ LLN were compared to diagnose restriction based on lung volume measurements. In all, 18,282 pulmonary function tests from 8,315 patients were analyzed. Twenty-six percent of the patients (n = 2,213) had restriction based on lung volume measurements. The sensitivity, specificity, PPV, and NPV of FVC < LLN to diagnose restriction based on lung volume measurement criteria were 88.6%, 56.8%, 39.9%, and 93.9%, respectively. The sensitivity, specificity, PPV, and NPV of FVC < LLN and FEV1/FVC ≥ normal to diagnose restriction based on lung volume criteria were 72.4%, 87.1%, 64.4%, and 90.7%, respectively. Analysis of ROC curves showed that spirometric criteria based on FVC alone performed better (area under the curve = 0.817) than those based on the combined criteria of FVC and FEV1/FVC (area under the curve = 0.584). Consistent with earlier findings, the negative predictive value for a normal FVC (≥ LLN) to exclude pulmonary restriction was high in this series (up to 95.7%). Also, a spirometric diagnosis of “restriction” (FVC < LLN and FEV1/FVC ≥ LLN) had a positive predictive value of 26.3–73.9%. On this basis, normal FVC can be regarded as excluding restriction with high reliability.

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Correspondence to Saiprakash B. Venkateshiah.

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Saiprakash B. Venkateshiah and Octavian C. Ioachimescu authors contributed equally to this work.

Appendix

Appendix

The appendix includes tables that evaluate spirometric criteria for restriction with various lung volume measurement definitions of restriction for the entire database, including repeated mesurements on the same patients.

Table A1 Comparison of FVC < LLN with lung volume measurements by plethysmography
Table  A2 Comparison of FVC < LLN with lung volume measurements by HeD
Table  A3 Comparison of FVC < LLN with lung volume measurements by plethysmography and HeD combined (i.e., criteria for restriction were satisfied if either the HeD or the Pleth measurements were below the LLN)
Table  A4 Comparison of FVC < LLN and FEV1/FVC ≥ LLN with lung volume measurements by plethysmography
Table  A5 Comparison of FVC < LLN and FEV1/FVC ≥ LLN with lung volume measurements by HeD
Table A6 Comparison of FVC < LLN and FEV1/FVC ≥ LLN with lung volume measurements by plethysmography and HeD combined (i.e., criteria for restriction were satisfied if either the HeD or Pleth measurements were below the LLN)

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Venkateshiah, S.B., Ioachimescu, O.C., McCarthy, K. et al. The Utility of Spirometry in Diagnosing Pulmonary Restriction. Lung 186, 19–25 (2008). https://doi.org/10.1007/s00408-007-9052-8

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  • DOI: https://doi.org/10.1007/s00408-007-9052-8

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