Overview of pulmonary function testing in adults
- Meredith C McCormack, MD, MHS
Meredith C McCormack, MD, MHS
- Assistant Professor of Medicine
- Medical Director, Pulmonary Function Laboratory Pulmonary and Critical Care Medicine Johns Hopkins University
Evaluation of pulmonary function is important in many clinical situations, both when the patient has a history or symptoms suggestive of lung disease and when risk factors for lung disease are present, such as occupational exposure to agents with known lung toxicity .
The European Respiratory Society and the American Thoracic Society have published guidelines for the measurement and interpretation of pulmonary function tests (PFTs) [2-5].
An overview of pulmonary function testing will be presented here, summarizing the types of PFTs and their indications. Specific aspects of pulmonary function testing are discussed elsewhere. (See "Office spirometry" and "Reference values for pulmonary function testing" and "Diffusing capacity for carbon monoxide" and "Pulmonary function testing in asthma" and "Bronchoprovocation testing" and "Overview of pulmonary function testing in children".)
PULMONARY FUNCTION TESTS
The major types of pulmonary function tests (PFTs) are spirometry, spirometry before and after a bronchodilator, lung volumes, and quantitation of diffusing capacity for carbon monoxide. Additional PFTs, such as measurement of maximal respiratory pressures, flow-volume loops, submaximal exercise testing, and bronchoprovocation challenge, are useful in specific clinical circumstances (table 1).
In preparation for PFTs, bronchodilator medications are typically held so that bronchodilator response can be assessed after baseline spirometry. As examples, short-acting inhaled bronchodilators (eg, albuterol, salbutamol, formoterol, ipratropium) should not be used for four hours prior to testing . Long-acting beta-agonist bronchodilators (eg, salmeterol, formoterol) are omitted for 12 hours prior to testing, and the long-acting anticholinergic agents glycopyrrolate (glycopyrronium), tiotropium, and umeclidinium are omitted for 24 hours. Aclidinium would be omitted for 12 hours, based on twice daily dosing.
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- PULMONARY FUNCTION TESTS
- - Post-bronchodilator
- - Flow-volume loop
- - Bronchoprovocation challenge
- - Supine and sitting spirometry
- Lung volumes
- Maximal respiratory pressures
- Diffusing capacity
- Submaximal exercise testing
- - Six-minute walk test
- - Incremental shuttle walk test
- - Endurance shuttle walk test
- Pulse oxygen saturation
- Arterial blood gases
- CLINICAL USE OF PULMONARY FUNCTION TESTS
- Chronic dyspnea
- Chronic obstructive pulmonary disease
- Upper airway obstruction
- Restrictive ventilatory defect
- Pulmonary vascular disease
- Preoperative testing
- Respiratory impairment and disability assessment
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS