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Research ArticleOriginal Research

Frequency and Causes of Combined Obstruction and Restriction Identified in Pulmonary Function Tests in Adults

Enrique Diaz-Guzman, Kevin McCarthy, Alan Siu and James K Stoller
Respiratory Care March 2010, 55 (3) 310-316;
Enrique Diaz-Guzman
Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.
MD
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Kevin McCarthy
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio.
RCPT
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Alan Siu
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio.
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James K Stoller
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio.
MD MSc FAARC
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Abstract

BACKGROUND: The frequency of combined obstruction and restriction identified in pulmonary function tests has not been well described. Moreover, although the causes of combined-obstruction-and-restriction patterns are known, the frequency of the various etiologies has received little attention.

METHODS: We retrospectively reviewed medical records and surveyed pulmonologists.

RESULTS: 43,212 PFT sessions were evaluated, which yielded 130 patients who satisfied our criteria for spirometry evidence of combined obstruction and restriction. Their demographic features were: mean ± SD age 54 ± 14 y, 51% male, mean ± SD body mass index 28.8 ± 6.7 kg/m2, mean ± SD height 174 ± 9 cm (men) and 162 ± 7 cm (women). The causes of combined obstruction and restriction were classified as either a pulmonary parenchymal disorder (Group A, n = 49, 38%) or a combination of pulmonary parenchymal and non-pulmonary diseases (Group B, n = 63, 48%). In 18 patients (14%) no clear etiology of combined obstruction and restriction could be determined. The most common pulmonary disease was chronic obstructive pulmonary disease (45/130, 35%), and the most common non-parenchymal disease was congestive heart failure (27/130, 21%). We electronically sent a survey to 55 pulmonary physicians, of whom 30 (55%) responded. The respondents estimated that combined obstruction and restriction occurs in approximately 20% of all the pulmonary function tests performed in their practices and that pulmonary parenchymal diseases were responsible for 35% of all instances of combined obstruction and restriction.

CONCLUSIONS: Combined obstruction and restriction occurs infrequently and is more commonly caused by a combination of pulmonary parenchymal and non-pulmonary disorders. Pulmonologists' impressions regarding the frequency and causes are generally discordant with the observed frequencies.

  • pulmonary function tests
  • spirometry
  • airway obstruction
  • lung disease, interstitial

Footnotes

  • Correspondence: James K Stoller MD MSc FAARC, Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, A90, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland OH 44195. E-mail: stollej{at}ccf.org.
  • Dr Stoller has disclosed relationships with Boehringer-Ingelheim, Talecris, CSL Behring, Asmatx, Grifols, Baxter, Philips-Respironics. The other authors have disclosed no conflicts of interest.

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (3)
Respiratory Care
Vol. 55, Issue 3
1 Mar 2010
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Frequency and Causes of Combined Obstruction and Restriction Identified in Pulmonary Function Tests in Adults
Enrique Diaz-Guzman, Kevin McCarthy, Alan Siu, James K Stoller
Respiratory Care Mar 2010, 55 (3) 310-316;

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Frequency and Causes of Combined Obstruction and Restriction Identified in Pulmonary Function Tests in Adults
Enrique Diaz-Guzman, Kevin McCarthy, Alan Siu, James K Stoller
Respiratory Care Mar 2010, 55 (3) 310-316;
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Keywords

  • pulmonary function tests
  • spirometry
  • airway obstruction
  • lung disease, interstitial

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