Pulmonary function testing in asthma
- Charles G Irvin, PhD, FERS
Charles G Irvin, PhD, FERS
- University of Vermont Department of Medicine
The "classic" signs and symptoms of asthma are intermittent dyspnea, cough, and wheezing. While typical of asthma, these symptoms are nonspecific, making it difficult to distinguish asthma from other respiratory diseases. The definitive diagnosis of asthma requires the history or presence of respiratory symptoms consistent with asthma, combined with the demonstration of variable expiratory airflow obstruction [1,2].
The use of pulmonary function testing in the diagnosis of asthma will be reviewed here. The diagnosis of asthma and the performance and interpretation of pulmonary function tests are discussed separately. (See "Diagnosis of asthma in adolescents and adults" and "Overview of pulmonary function testing in adults" and "Office spirometry".)
TESTS FOR THE DIAGNOSIS OF ASTHMA
The diagnosis of asthma is based upon a compatible clinical history and characteristic findings from a series of pulmonary function tests (PFTs) [1-3]. An approach to the use of PFTs in the diagnosis of asthma is provided in the algorithm (algorithm 1). The clinical features and diagnosis of asthma are discussed separately. (See "Diagnosis of asthma in adolescents and adults", section on 'Clinical features'.)
The specific PFTs are selected to identify the characteristic features of asthma, which include [1,2]:
●Variable airflow limitation, which can be either circadian or episodic in nature
Subscribers log in hereLiterature review current through: Sep 2017. | This topic last updated: Oct 11, 2016.References
- 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) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on December 04, 2014).
- Global Initiative for Asthma. Global strategy for asthma management and prevention (Updated 2015). http://www.ginasthma.org/local/uploads/files/GINA_Report_2015_Aug11.pdf (Accessed on March 01, 2016).
- Irvin, CG. Evaluation of Pulmonary Function. In: Physiologic Basis of Respiratory Disease, Hamid, Q, Martin, J, Shannon, J (Eds), Dekker, Ontario 2005.
- Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26:319.
- Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26:948.
- 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 28, 2016).
- Tepper RS, Wise RS, Covar R, et al. Asthma outcomes: pulmonary physiology. J Allergy Clin Immunol 2012; 129:S65.
- Brown RH, Pearse DB, Pyrgos G, et al. The structural basis of airways hyperresponsiveness in asthma. J Appl Physiol (1985) 2006; 101:30.
- Modrykamien AM, Gudavalli R, McCarthy K, et al. Detection of upper airway obstruction with spirometry results and the flow-volume loop: a comparison of quantitative and visual inspection criteria. Respir Care 2009; 54:474.
- Sterner JB, Morris MJ, Sill JM, Hayes JA. Inspiratory flow-volume curve evaluation for detecting upper airway disease. Respir Care 2009; 54:461.
- Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991; 144:1202.
- Quadrelli SA, Roncoroni AJ, Montiel GC. Evaluation of bronchodilator response in patients with airway obstruction. Respir Med 1999; 93:630.
- Smith HR, Irvin CG, Cherniack RM. The utility of spirometry in the diagnosis of reversible airways obstruction. Chest 1992; 101:1577.
- Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med 1994; 149:S9.
- 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.
- Kaminsky DA, Irvin CG. What long-term changes in lung function can tell us about asthma control. Curr Allergy Asthma Rep 2015; 15:505.
- McFadden ER Jr, Kiser R, DeGroot WJ. Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med 1973; 288:221.
- Pennock BE, Cottrell JJ, Rogers RM. Pulmonary function testing. What is 'normal'? Arch Intern Med 1983; 143:2123.
- 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.
- 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.
- Peress L, Sybrecht G, Macklem PT. The mechanism of increase in total lung capacity during acute asthma. Am J Med 1976; 61:165.
- Collard P, Njinou B, Nejadnik B, et al. Single breath diffusing capacity for carbon monoxide in stable asthma. Chest 1994; 105:1426.
- 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.
- Global Initiative for Chronic Obstructive Lung Disease. Asthma, COPD, and Asthma-COPD Overlap Syndrome. http://goldcopd.org/asthma-copd-asthma-copd-overlap-syndrome/ (Accessed on August 22, 2016).
- 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.
- Finucane KE, Colebatch HJ. Elastic behavior of the lung in patients with airway obstruction. J Appl Physiol 1969; 26:330.
- 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.
- Irvin, CG, Cherniack, RM. Pathophysiology and physiologic assessment of the asthmatic patient. Semin Respir Med 1987; 8:201.
- 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.
- TESTS FOR THE DIAGNOSIS OF ASTHMA
- Flow-volume relationships
- Bronchodilator responses
- Peak expiratory flow
- Bronchoprovocation challenge
- Fraction of exhaled nitric oxide
- MONITORING ASTHMA
- EFFECT OF ASTHMA ON OTHER PULMONARY FUNCTION TESTS
- Lung volumes
- - Overview
- - Residual volume
- - Functional residual capacity
- - Total lung capacity
- Diffusing capacity
- ADDITIONAL TESTING IN PATIENTS WITH COMORBID DISEASE
- RESEARCH TOOLS FOR ASSESSMENT OF AIRFLOW LIMITATION