Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Use of pulmonary function testing in the diagnosis of asthma

INTRODUCTION

The pathophysiology of asthma is characterized by a pattern of lung dysfunction that includes [1,2]:

Airflow limitation that reverses with bronchodilator administration.

Variable airflow limitation, which can be either circadian or episodic in nature.

Airways hyperresponsiveness, which is an excessive decrease in airflow in response to specific stimuli or "triggers" (see "Risk factors for asthma").

Unlike other pulmonary diseases, asthma cannot be identified by a definitive pathologic picture or one diagnostic test. Rather, the diagnosis of asthma is based upon an appropriate clinical history and characteristic findings from a series of pulmonary function tests [1-4]. These tests most often include different measures of airflow, bronchodilator responses, lung volumes, and the diffusing capacity.

                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Jan 16, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Irvin, CG, Cherniack, RM. Pathophysiology and physiologic assessment of the asthmatic patient. Semin Respir Med 1987; 8:201.
  2. Wagers, S, Jaffe, EF, Irvin, CG. Development, Structure, and Physiology in Normal and Asthmatic Lung. In: Middleton's allergy principles and practice, 6th Ed, Adkinson, NF Jr, Busse, WW, Yunginger, JW, et al (Eds), Elsevier, St Louis 2003.
  3. Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med 1994; 149:S9.
  4. Irvin, CG. Evaluation of Pulmonary Function. In: Physiologic Basis of Respiratory Disease, Hamid, Q, Martin, J, Shannon, J (Eds), Dekker, Ontario 2005.
  5. Crapo RO. Pulmonary-function testing. N Engl J Med 1994; 331:25.
  6. Pennock BE, Cottrell JJ, Rogers RM. Pulmonary function testing. What is 'normal'? Arch Intern Med 1983; 143:2123.
  7. National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). Available from www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. (Accessed April 11, 2008).
  8. U.S. Department of Health and Human Services. International consensus report on diagnosis and treatment of asthma. U.S. Government Printing Office, Washington D.C. PHHS Publication No. 92-3091, 1992.
  9. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26:319.
  10. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991; 144:1202.
  11. Smith HR, Irvin CG, Cherniack RM. The utility of spirometry in the diagnosis of reversible airways obstruction. Chest 1992; 101:1577.
  12. Tepper RS, Wise RS, Covar R, et al. Asthma outcomes: pulmonary physiology. J Allergy Clin Immunol 2012; 129:S65.
  13. Brown RH, Pearse DB, Pyrgos G, et al. The structural basis of airways hyperresponsiveness in asthma. J Appl Physiol (1985) 2006; 101:30.
  14. Quadrelli SA, Roncoroni AJ, Montiel GC. Evaluation of bronchodilator response in patients with airway obstruction. Respir Med 1999; 93:630.
  15. Mead J, Turner JM, Macklem PT, Little JB. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol 1967; 22:95.
  16. McFadden ER Jr, Kiser R, DeGroot WJ. Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med 1973; 288:221.
  17. Martin J, Powell E, Shore S, et al. The role of respiratory muscles in the hyperinflation of bronchial asthma. Am Rev Respir Dis 1980; 121:441.
  18. Kraft M, Cairns CB, Ellison MC, et al. Improvements in distal lung function correlate with asthma symptoms after treatment with oral montelukast. Chest 2006; 130:1726.
  19. Peress L, Sybrecht G, Macklem PT. The mechanism of increase in total lung capacity during acute asthma. Am J Med 1976; 61:165.
  20. Collard P, Njinou B, Nejadnik B, et al. Single breath diffusing capacity for carbon monoxide in stable asthma. Chest 1994; 105:1426.
  21. Desjardin JA, Sutarik JM, Suh BY, Ballard RD. Influence of sleep on pulmonary capillary volume in normal and asthmatic subjects. Am J Respir Crit Care Med 1995; 152:193.
  22. American Thoracic Society. Single-breath carbon monoxide diffusing capacity (transfer factor). Recommendations for a standard technique--1995 update. Am J Respir Crit Care Med 1995; 152:2185.
  23. Kikuchi Y, Okabe S, Tamura G, et al. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med 1994; 330:1329.
  24. Finucane KE, Colebatch HJ. Elastic behavior of the lung in patients with airway obstruction. J Appl Physiol 1969; 26:330.
  25. Gold WM, Kaufman HS, Nadel JA. Elastic recoil of the lungs in chronic asthmatic patients before and after therapy. J Appl Physiol 1967; 23:433.