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Breathing Out: Forced Exhalation, Airflow Limitation

  • James A. Stockley
  • Brendan G. Cooper
Chapter
Part of the Respiratory Medicine book series (RM)

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.

Keywords

Spirometry Ventilation Obstruction Restriction Therapy assessment 

Selected References

  1. 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.CrossRefGoogle Scholar
  2. British Thoracic Society & Association for Respiratory Technology and Physiology. Guidelines for the measurement of respiratory function. Respir Med. 1994;88:165–94.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. Cooper BG. Spirometry standards and FEV1/FVC repeatability. Prim Care Respir J. 2010;19:292–4.CrossRefGoogle Scholar
  5. Cooper BG. An update on contraindications for lung function testing. Thorax. 2011;66:714–23.CrossRefGoogle Scholar
  6. Cooper BG, Hunt JH, Kendrick AH, et al. ARTP practical handbook of spirometry. 3rd ed. London: Association for Respiratory Technology and Physiology; 2017. ISBN: 0-9536898-6-7Google Scholar
  7. Cotes JE, Chinn DJ, Miller MR. Lung function. 6th ed. Malden, MA: Blackwell Publishing; 2006. ISBN: 0632064935CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977;1:1645–8.CrossRefGoogle Scholar
  10. Gardner ZE, Ruppel GL, Kaminsky DA. Grading the severity of obstruction in mixed obstructive-restrictive lung disease. Chest. 2011;140:598–603.CrossRefGoogle Scholar
  11. Hansen JE, Sun XG, Adame D, Wasserman K. Argument for changing criteria for bronchodilator responsiveness. Respir Med. 2008;102:1777–83.CrossRefGoogle Scholar
  12. Hughes JMB, Pride NB. Lung function tests: physiological principle and clinical applications. London: Bailliere Tindall; 1999. ISBN: 0702023507Google Scholar
  13. Kendrick AH, Johns DP, Leeming JP. Infection control of lung function equipment: a practical approach. Respir Med. 2003;97:1163–79.CrossRefGoogle Scholar
  14. Laszlo G. Pulmonary function: a guide for clinicians. New York: Cambridge University Press; 1994. ISBN: 0521446791Google Scholar
  15. 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.CrossRefGoogle Scholar
  16. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.CrossRefGoogle Scholar
  17. Miller MR, Hankinson J, Brusasko V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. Miller MR. Does the use of per cent predicted have any evidence base? Eur Respir J. 2015;45(2):322–3.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. Pellegrino R, Viegi G, Brusasco V, et al. Interpretive strategies for lung function tests. Eur Respir J. 2005;26:948–68.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. Quanjer PH, Cooper B, Ruppel GL, et al. Defining airflow obstruction. Eur Respir J. 2015;45:561–2.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. Seed L, Wilson D, Coates AL. Children should not be treated like little adults in the PFT lab. Respir Care. 2012;57:61–74.CrossRefGoogle Scholar
  28. 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.Google Scholar
  29. Ward H, Cooper BG, Miller MR. Improved criterion for assessing lung function reversibility. Chest. 2015;148(4):877–86.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Lung Function and Sleep DepartmentQueen Elizabeth Hospital BirminghamBirminghamUK

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