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The Use of the Pulmonary Function Laboratory in Diagnosing Asthma

  • Michael Schivo
  • Amir A. Zeki
  • Nicholas J. Kenyon
  • Timothy E. Albertson
Chapter

Abstract

This chapter aims to provide the general clinician with a good understanding of available tests in the pulmonary function laboratory to help characterize asthma. It focuses on how tests are defined and performed, their limitations, their interpretations, and how to use them to follow asthma over time. Bronchoprovocation testing is also discussed, and utilization of arterial blood gas tests to help make acute triage decisions is reviewed. The key elements pertinent to each topic are listed in the “Key Points” at the beginning of this chapter.

Keywords

Chronic Obstructive Pulmonary Disease Lung Volume Forced Vital Capacity Functional Residual Capacity Obstructive Lung Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors wish to thank Richard E. Kanner, MD, and Theodore G. Liou, MD, authors of the prior edition of this chapter, for laying the groundwork from which we could write this edition.

References

  1. 1.
    Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948–968.PubMedCrossRefGoogle Scholar
  2. 2.
    National Heart Lung, and Blood Institute. Expert panel report 3: Guidelines for the diagnosis and management of asthma – full report 2007. wwwnhlbinihgov/guidelines/asthma. August 28, 2007.Google Scholar
  3. 3.
    Gautrin D, D’Aquino LC, Gagnon G, Malo JL, Cartier A. Comparison between peak expiratory flow rates (PEFR) and FEV1 in the monitoring of asthmatic subjects at an outpatient clinic. Chest 1994;106:1419–1426.PubMedCrossRefGoogle Scholar
  4. 4.
    McFadden ER, Jr., Linden DA. A reduction in maximum mid-expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med 1972;52:725–737.PubMedCrossRefGoogle Scholar
  5. 5.
    Simon MR, Chinchilli VM, Phillips BR, Sorkness CA, Lemanske RF, Jr., Szefler SJ, Taussig L, Bacharier LB, Morgan W. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values. J Allergy Clin Immunol 2010;126:527–534 e521-528.Google Scholar
  6. 6.
    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J 2005;26:319–338.PubMedCrossRefGoogle Scholar
  7. 7.
    Harris TR, Pratt PC, Kilburn KH. Total lung capacity measured by roentgenograms. Am J Med 1971;50:756–763.PubMedCrossRefGoogle Scholar
  8. 8.
    Fleming GM, Chester EH, Saniie J, Saidel GM. Ventilation inhomogeneity using multibreath nitrogen washout: Comparison of moment ratios and other indexes. Am Rev Respir Dis 1980;121:789–794.PubMedGoogle Scholar
  9. 9.
    Nensa F, Marek W, Marek E, Smith HJ, Kohlhaufl M. Assessment of airway hyperreactivity: Comparison of forced spirometry and body plethysmography for methacholine challenge tests. Eur J Med Res 2009;14 Suppl 4:170–176.PubMedGoogle Scholar
  10. 10.
    Mahut B, Trinquart L, Bokov P, Le Bourgeois M, Waernessyckle S, Peiffer C, Delclaux C. Relationships between specific airway resistance and forced expiratory flows in asthmatic children. PLoS One 2009;4:e5270.PubMedCrossRefGoogle Scholar
  11. 11.
    Sin BA, Akkoca O, Saryal S, Oner F, Misirligil Z. Differences between asthma and copd in the elderly. J Investig Allergol Clin Immunol 2006;16:44–50.PubMedGoogle Scholar
  12. 12.
    Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller MR, Navajas D, Pedersen OF, Pellegrino R, Wanger J. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 2005;26:720–735.PubMedCrossRefGoogle Scholar
  13. 13.
    Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. General considerations for lung function testing. Eur Respir J 2005;26:153–161.PubMedCrossRefGoogle Scholar
  14. 14.
    Morris AH, Intermountain Thoracic Society. Clinical pulmonary function testing: A manual of uniform laboratory procedures. Salt Lake City, Utah: Intermountain Thoracic Society; 1984.Google Scholar
  15. 15.
    Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159:179–187.PubMedGoogle Scholar
  16. 16.
    Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981;123:659–664.PubMedGoogle Scholar
  17. 17.
    Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis 1993;147:125–133.PubMedGoogle Scholar
  18. 18.
    Ip MS, Ko FW, Lau AC, Yu WC, Tang KS, Choo K, Chan-Yeung MM. Updated spirometric reference values for adult chinese in Hong Kong and implications on clinical utilization. Chest 2006;129:384–392.PubMedCrossRefGoogle Scholar
  19. 19.
    Fulambarker A, Copur AS, Javeri A, Jere S, Cohen ME. Reference values for pulmonary function in Asian Indians living in the united states. Chest 2004;126:1225–1233.PubMedCrossRefGoogle Scholar
  20. 20.
    Garcia-Rio F, Pino JM, Dorgham A, Alonso A, Villamor J. Spirometric reference equations for European females and males aged 65–85 yrs. Eur Respir J 2004;24:397–405.PubMedCrossRefGoogle Scholar
  21. 21.
    Global initiative of chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2009 update.: Published by Medical Communications Resources, Inc.; 2009.Google Scholar
  22. 22.
    Woolcock AJ, Read J. Lung volumes in exacerbations of asthma. Am J Med 1966;41:259–273.PubMedCrossRefGoogle Scholar
  23. 23.
    Reddy C. Bronchoprovocation testing. Clin Rev Allergy Immunol 2009;37:167–172.CrossRefGoogle Scholar
  24. 24.
    Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, MacIntyre NR, McKay RT, Wanger JS, Anderson SD, Cockcroft DW, Fish JE, Sterk PJ. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS board of directors, July 1999. Am J Respir Crit Care Med 2000;161:309–329.PubMedGoogle Scholar
  25. 25.
    Perpina M, Pellicer C, de Diego A, Compte L, Macian V. Diagnostic value of the bronchial provocation test with methacholine in asthma. A bayesian analysis approach. Chest 1993;104:149–154.PubMedCrossRefGoogle Scholar
  26. 26.
    Randolph C. Exercise-induced asthma: Update on pathophysiology, clinical diagnosis, and treatment. Curr Probl Pediatr 1997;27:53–77.PubMedCrossRefGoogle Scholar
  27. 27.
    Haby MM, Anderson SD, Peat JK, Mellis CM, Toelle BG, Woolcock AJ. An exercise challenge ­protocol for epidemiological studies of asthma in children: Comparison with histamine challenge. Eur Respir J 1994;7:43–49.PubMedCrossRefGoogle Scholar
  28. 28.
    Foschino Barbaro MP, Lacedonia D, Palladino GP, Bergantino L, Ruggeri C, Martinelli D, Carpagnano GE. Dyspnea perception in asthma: Role of airways inflammation, age and emotional status. Respir Med 2010;105:195–203.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Michael Schivo
    • 1
    • 2
    • 3
  • Amir A. Zeki
    • 1
    • 2
    • 3
  • Nicholas J. Kenyon
    • 1
    • 2
    • 3
  • Timothy E. Albertson
    • 4
    • 3
  1. 1.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineUniversity of California at DavisSacramentoUSA
  2. 2.UC Davis Center for Comparative Respiratory Biology and MedicineDavisUSA
  3. 3.VA Northern California Health Care SystemMatherUSA
  4. 4.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and Department of Emergency MedicineUniversity of California at DavisSacramentoUSA

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