Assessment of Pulmonary Function in COPD
Assessment of Pulmonary Function in COPD
Pulmonary function testing is used in the diagnosis of chronic obstructive pulmonary disease (COPD) and the staging of COPD severity. The current diagnostic criterion for airflow obstruction is a ratio of forced expiratory volume in 1 second (FEV1)to forced vital capacity (FVC) < 70%. However this absolute definition can lead to false-negative determinations in younger patients and false-positive determinations in the elderly. Nevertheless, screening spirometry is advocated and becomes feasible in the physician office setting with the availability of compact, relatively affordable apparatus that meets the appropriate technical specifications. Spirometry should be complemented by measurement of lung volumes using body plethysmography in those with evidence of airflow obstruction. Small airways disease can be detected by various techniques that measure airway and total respiratory system resistance. There is renewed interest in the forced oscillation technique and impulse oscillometry because of their noninvasiveness and potential ability to distinguish small from larger airway disease. Finally, pulmonary function testing has an important role in preoperative risk assessment; for example, in patients being considered for lung volume reduction surgery or resection of a lung nodule.
The hallmark of chronic obstructive pulmonary disease (COPD) is airflow obstruction. This is identified by pulmonary function testing and thereby used for the diagnosis of COPD and staging of disease severity. Thus COPD is now defined by a reduction in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) < 70%, and the severity of the disease recognizes the progressive decline in FEV1 over time that is characteristic of COPD (see Fig. 1). Assessment of pulmonary function is therefore an important consideration in COPD and various issues surround its methodology and validity.
(Enlarge Image)
Progressive decline in forced expiuratory volume in 1 second (FEV1) in patients with chronic obstructive pulmonary disease. (Modified with permission from Fletcher and Peto.)
Pulmonary function testing is used in the diagnosis of chronic obstructive pulmonary disease (COPD) and the staging of COPD severity. The current diagnostic criterion for airflow obstruction is a ratio of forced expiratory volume in 1 second (FEV1)to forced vital capacity (FVC) < 70%. However this absolute definition can lead to false-negative determinations in younger patients and false-positive determinations in the elderly. Nevertheless, screening spirometry is advocated and becomes feasible in the physician office setting with the availability of compact, relatively affordable apparatus that meets the appropriate technical specifications. Spirometry should be complemented by measurement of lung volumes using body plethysmography in those with evidence of airflow obstruction. Small airways disease can be detected by various techniques that measure airway and total respiratory system resistance. There is renewed interest in the forced oscillation technique and impulse oscillometry because of their noninvasiveness and potential ability to distinguish small from larger airway disease. Finally, pulmonary function testing has an important role in preoperative risk assessment; for example, in patients being considered for lung volume reduction surgery or resection of a lung nodule.
The hallmark of chronic obstructive pulmonary disease (COPD) is airflow obstruction. This is identified by pulmonary function testing and thereby used for the diagnosis of COPD and staging of disease severity. Thus COPD is now defined by a reduction in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) < 70%, and the severity of the disease recognizes the progressive decline in FEV1 over time that is characteristic of COPD (see Fig. 1). Assessment of pulmonary function is therefore an important consideration in COPD and various issues surround its methodology and validity.
(Enlarge Image)
Progressive decline in forced expiuratory volume in 1 second (FEV1) in patients with chronic obstructive pulmonary disease. (Modified with permission from Fletcher and Peto.)