Chest
Original ResearchPhysiologic TestingConditions Associated With an Abnormal Nonspecific Pattern of Pulmonary Function Tests
Section snippets
Subject Selection
We performed a retrospective analysis of subjects studied in our pulmonary function laboratory between 1991 and 2000. Selection criteria were that subjects be ≥ 20 years old with an FEV1 and FVC below the lower limit of normal, and the FEV1/FVC, TLC, and Dlco above the lower limit of normal. All subjects had received a bronchodilator or methacholine challenge.8 Over this time period, bronchodilator tests were routinely performed in all complete test referrals unless the ordering physician
Patient Characteristics
Table 1 presents pertinent group data. AHR on the index test was found in 4 of 12 subjects who received methacholine and in 29 of 88 subjects who received a bronchodilator. When we reviewed the medical records and all available test results, evidence of AHR, defined as a clinical diagnosis of asthma and/or a positive bronchodilator or methacholine response, was found in an additional 23 subjects for a total of 56 subjects. Thus, there was a positive bronchodilator response in 40 subjects, a
Discussion
The strength of the study included having the tests performed by technicians who follow tight quality control and perform thousands of tests a year. Reproducibility of MEFV curves was used to monitor and ensure maximal patient performance. The availability of medical records, often covering many years, was very important in categorizing diagnoses. It was possible to review multiple tests in 40% of the sample. Critical to our analyses was having the TLC measured by body plethysmography. Had we
Acknowledgment
The authors thank Kenneth O. Parker and Patricia Muldrow for their valuable assistance.
References (20)
Small airways obstruction syndrome
Chest
(1999)- et al.
How accurate is spirometry at predicting restrictive pulmonary impairment?
Chest
(1999) - et al.
Imaging the lungs in asthmatic patients by using hyperpolarized helium-3 magnetic resonance: assessment of response to methacholine and exercise challenge
J Allergy Clin Immunol
(2003) - et al.
Maximal expiratory flow and total respiratory resistance during induced bronchoconstriction in asthmatic subjects
Am Rev Respir Dis
(1972) - et al.
Lung mechanics during provocation of asthma
Clin Sci
(1971) - et al.
- et al.
A normal FEV1/VC ratio does not exclude airway obstruction
Respiration
(2004) - et al.
Interpretative strategies for lung function tests
Eur Respir J
(2005) - et al.
Conditions associated with the “nonspecific” spirometric abnormality [abstract]
Am J Respir Crit Care Med
(2007) - et al.
Methacholine aerosol as test for bronchial asthma
Arch Intern Med
(1965)
Cited by (91)
Restricted spirometry through the lifespan
2022, The Lancet Respiratory MedicineLung Function Testing in Chronic Obstructive Pulmonary Disease
2020, Clinics in Chest MedicineDiffusing capacity in normal-for-age spirometry and spirometric impairments, using reference equations from the global lung function initiative
2020, Respiratory MedicineCitation Excerpt :We evaluated a large study sample with a wide age range and applied rigorous age-appropriate methods for establishing impairments in spirometry and diffusion. We acknowledge, however, that a more detailed assessment is required to establish the diagnoses underlying impairments in spirometry and diffusion, including: history and physical exam, and select use of static lung volumes, respiratory muscle pressures, chest imaging, and echocardiography [2,11,17,23–38]. In particular, the American Thoracic and European Respiratory Societies (ATS/ERS) recommend static lung volumes to confirm a restrictive ventilatory defect (TLC < LLN) and to evaluate a mixed restrictive and obstructive ventilatory defect (FEV1/FVC and TLC < LLN) [5,39,40].
This research was supported by the Mayo Clinic, Rochester, MN.
Drs. Hyatt, Cowl, and Bjoraker have no conflicts of interest to disclose. Dr. Scanlon has received support from Pharmaceuticals, GlaxoSmithKline, Pfizer, Dey L.P. Pharmaceutical, and Novartis.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).