Chest
Original ResearchPulmonary Function TestingGrading the Severity of Obstruction in Mixed Obstructive-Restrictive Lung Disease
Section snippets
Materials and Methods
We analyzed a large database of pulmonary function tests (PFTs) collected at St. Louis University Hospital. Equipment and techniques were unchanged throughout the study period and strictly conformed to ATS/ERS criteria for quality.14, 15 The study received exempt status approval from the St. Louis University Biomedical Institutional Review Board (#16311) and the University of Vermont Committees on Human Research (#10-055) because all data were deidentified at the time of analysis.
We identified
Results
We identified a total of 199 patients with coexisting restrictive and obstructive lung disease. Of these patients, 37% were women and 74% were white (Table 1). The mean age was 56 ± 14 years; the mean FEV1, 1.5 ± 0.6 L (42 ± 14% predicted); mean FEV1/FVC, 0.61 ± 0.06; and mean TLC, 4.5 ± 1 L (71 ± 7% predicted). Based on referral requests, patients had a variety of lung diseases, which were categorized into obstructive diseases (eg, asthma, COPD, bronchiectasis), interstitial lung diseases (eg,
Discussion
Current ATS/ERS guidelines1 recommend using the FEV1 % predicted to grade the severity of lung disease in the presence of obstruction, restriction, or mixed disorders. Because FEV1 is such a strong, independent predictor of health status, this recommendation is sensible. However, in the presence of mixed disorders, the severity of the obstructive component alone also might be assessed on the basis of FEV1, an approach that would be expected to overestimate the degree of obstruction because the
Acknowledgments
Author contributions: Dr Kaminsky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Gardner: contributed to the study design; data collection, analysis, and interpretation; and writing of the manuscript.
Mr Ruppel: contributed to the data collection and interpretation and review of the manuscript.
Dr Kaminsky: contributed to the study design; data collection, analysis, and interpretation; and writing of
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Funding/Support: This work was supported by the Vermont Lung Center.
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