Variability in Interpretation of Pulmonary Function Tests

doi:10.1378/chest.76.4.389

Chest

Volume 76, Issue 4, October 1979, Pages 389-390

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We asked 26 pulmonary physicians to interpret results of ten consecutive pulmonary function tests from one laboratory. There was frequent disagreement in their assessment of respiratory impairment. This is likely due to the variety of criteria for grading the severity of obstructive and restrictive defects. Since the narrative interpretation of pulmonary function data may influence patient care, physicians should consider the numerical magnitude of the derangements, as well as the descriptive terms applied.

Section snippets

Methods

We asked the members of the respiratory disease staff and fellows from the University of Washington (UW) and practicing chest physicians in the state of Washington to interpret ten consecutive pulmonary function tests (PFT) from one laboratory. The tests were sequential and not selected to demonstrate specific points or to include difficult problems. Only the age, height, weight, predicted flow rates and lung volumes and the physiologic data from each patient were given to the interpreting

Results

Table 1 summarizes the results of the study. There was a striking frequency of disagreement in the interpretation of the pulmonary function tests. The magnitude of the disagreements was no different whether the physicians had considerable interaction as in the university group, or practiced independently, as in the statewide group.

Discussion

A review of the published criteria1, 2, 3, 4 for the interpretation of obstructive and restrictive lung disease provides insight into the results of the study. Figure 1 summarizes the suggested categories of obstructive disease from four sources.1, 2, 3, 4 The criteria of Ellis and colleagues⁸ were presented as percentages of the predicted FEV₁/VC ratio and for the purposes of this comparison we selected a predicted FEV₁/ VC ratio of 80 percent. In the range of FEV₁/VC ratios from 80 percent to

References (4)

JH Ellis et al.
A computer program for calculation and interpretation of pulmonary function studies
Chest
(1975)
EA Gaensler et al.
Evaluation of respiratory impairment
Arch Environ Health
(1966)

There are more references available in the full text version of this article.

Cited by (13)

Classifying Asthma: Disagreement Among Specialists
2003, Chest
The asthma practice guidelines developed by the National Institutes of Health include a system for classifying asthma severity. The goal of the present study was to assess the interrater reliability of this classification system by measuring agreement among pediatric asthma specialists.
A survey containing eight case summaries was mailed to 24 board-certified pediatric allergists and pulmonologists, who were asked to classify each case according to the national guidelines. The case summaries included the patient's medical history, physical examination, and chest radiograph and pulmonary function test results. Physicians were also asked to interpret the pulmonary function tests, to indicate the main factors used to classify each case (daytime symptoms, nighttime symptoms, pulmonary function testing, or various combinations), and to make treatment recommendations. κ statistics were used to measure agreement.
Fourteen of 24 surveys mailed (58%) were completed and returned. Agreement was poor for classifying asthma (κ = 0.29; 95% confidence interval [CI], 0.25 to 0.33) and for the main factors used to make the classifications (κ = 0.19; 95% CI, 0.14 to 0.23). Specialists exhibited higher agreement in their interpretation of pulmonary function tests (no asthma, κ = 0.66; asthma on baseline, κ = 0.53; exercise-induced asthma, κ = 0.65). While physicians' treatment recommendations were consistent with their severity classifications, the low level of agreement in those classifications led to substantial variability in the treatments recommended.
The low level of agreement among pediatric asthma specialists in classifying asthma severity suggests the need to refine the classification system used in the national guidelines to help ensure the consistent application of those guidelines.
La interpretación de la espirometría: ¿Dónde nos encontramos?
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Computerized rapid analysis of pulmonary function test: Use of a least mean squares correlation for interpretation of data
1982, Computers in Biology and Medicine
Although systems for automated calculation and interpretation of screening pulmonary function tests (PFT) have been discussed by previous investigators, these systems are often unavailable to other users, require large or hybrid computers, or are difficult to modify. The use of a branching decision tree for PFT interpretation may also limit the number of correlations possible and make revision of the program difficult because changes in the proximal branches of the tree require a rewriting of the entire distal program.
We have developed a system based on a minicomputer which uses a least mean squares analysis for rapidly analyzing the patient's PFT data. This program considers the following types of PFT data singly and in combination: percentage predicted total lung capacity and/or alveolar volume, forced expiratory volume in one second to forced vital capacity ratio (before and after bronchodilator or 80% helium challenge), and percentage predicted single breath diffusing capacity for carbon monoxide. The interpretation program (IP) then selects the ‘best interpretation’ for the patient by computing the variance between the patient's data and data from a menu of over 120 interpretation statements. During the past two years we have used this system for screening over 3000 patients. In about 90% of patients the computer selected interpretation statements which were acceptable to a sub-specialty pulmonary physician. The use of this IP for screening purposes has facilitated the efficient use of laboratory personnel and equipment.
The pulmonary function test. Cautious overinterpretation
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Reasons for referral for pulmonary function testing: An audit of 4 adult lung function laboratories
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: Manuscript received November 6; revision accepted December 19.

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Chest

Clinical InvestigationsVariability in Interpretation of Pulmonary Function Tests

Section snippets

Methods

Results

Discussion

Chest

Evaluation of respiratory impairment

Arch Environ Health

Clinical Investigations
Variability in Interpretation of Pulmonary Function Tests