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Overview of pulmonary function testing in adults

Meredith C McCormack, MD, MHS
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD


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 [1].

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 "Selecting reference values for pulmonary function tests" and "Diffusing capacity for carbon monoxide" and "Pulmonary function testing in asthma" and "Bronchoprovocation testing" and "Overview of pulmonary function testing in children".)


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 [5]. 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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Literature review current through: Oct 2017. | This topic last updated: Mar 11, 2016.
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