Interpreting Lung Function Tests: A Step-by Step Guide

By Bruce R. Thompson, Brigitte M. Borg and Robyn E. O'Hehir

Lung function assessment is the central pillar of modern respiratory diagnosis, providing invaluable information to assist in clinical decision making and management strategies.Interpreting Lung Function Tests: A Step-by Step Guide is a practical “how-to” training manual, which provides the reader with the necessary skills to interpret lung function test results, and to write a concise and informative report on the outcome.

Interpreting Lung Function Tests: A Step-by Step Guide  

• provides unique guidance on the reporting of pulmonary function tests, including illustrative cases and sample reports.
• utilizes the many references available on interpretation of lung function and provides a teaching/reference tool for report writing of lung function results routinely performed in clinical practice.
• provides the reader with the skill to interpret and write a concise, yet informative report
• provides examples of results and written reports (with commentary where necessary as further explanation).
• focuses primarily on tests performed as part of routine clinical testing: spirometry, static lung volumes, gas transfer, bronchial provocation tests, and maximal respiratory pressures.

Interpreting Lung Function Tests: A Step-by Step Guideis a superb new resource to educate medical students, junior doctors, family physicians, as well as advanced trainee physicians specializing in respiratory medicine, respiratory scientists, and respiratory physicians

• Language: English
• Publisher: Wiley
• Release date: Jul 11, 2014
• ISBN: 9781118405468

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Library of Congress Cataloging-in-Publication Data

Borg, Brigitte M. (Marianne), 1970- author.

Interpreting lung function tests : a step-by-step guide / Brigitte Marianne Borg, Bruce Robert Thompson, Robyn Elizabeth O'Hehir.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-118-40551-2 (pbk.)

I. Thompson, Bruce R. (Robert), 1967- author. II. O'Hehir, Robyn E. (Elizabeth), 1954- author. III. Title.

[DNLM: 1. Respiratory Function Tests. WF 141]

RC734.P84

616.2′40754— dc23

2014005432

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Courtsey of Professor Merryn Tawhai and Professor Bruce Thompson

About the authors

Ms Brigitte M. Borg

Brigitte Borg has a Bachelor of Applied Science (Medical Biophysics and Instrumentation) and is a Certified Respiratory Function Scientist. Brigitte is the Deputy Head of the Physiology Service, Allergy, Immunology and Respiratory Medicine at The Alfred, Melbourne. She is responsible for the day-to-day management of a busy lung function laboratory that encompasses clinical, research and education in its core activities. Brigitte has actively participated in the training of advanced trainees in lung function interpretation over many years and has been on the faculty of the American Thoracic Society's postgraduate course for the Interpretation of Lung Function since 2008. Brigitte's research interests are twofold: quality of measurement of lung function and oxygen therapy.

Professor Bruce R. Thompson

Professor Bruce Thompson, B. App. Sci, CRFS, PhD, FANZSRS, is the Head of the Physiology Service within the Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University. After graduating with a degree in Physiology and Electronics, he completed a PhD examining the effects of ventilation heterogeneity on gas transfer factor. Prof. Thompson is the head of one of the largest pulmonary function laboratories in Australia and combines a very active research programme. Prof. Thompson's research interest centres on the structure and function of the small airways, and he also has a very keen interest in quality of pulmonary function measurements. He is a member of the Global Lung Initiative TLCO taskforce. Finally, his contribution to respiratory research and laboratory measurement was recognised in 2011 when he was awarded the ANZSRS research medal (Fellowship).

Professor Robyn E O'Hehir

Professor O'Hehir, FRACP, PhD, FRCP, FRCPath, is Professor and Director of the Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University. After graduating in Science (Microbiology, Biochemistry and Physiology) and then in Medicine at Monash University and Alfred Hospital, Melbourne, Australia, she completed her clinical postgraduate training at Royal Brompton Hospital and the University of London, specialising in both Allergy and Clinical Immunology and Respiratory Medicine. Professor O'Hehir conducts an active programme combining clinical care, clinical and experimental research and education. She is an Editor of the international journal Clinical and Experimental Allergy and has a strong interest in translational medicine.

Forewords

Tell me and I forget, teach me and I may remember, involve me and I learn.

Benjamin Franklin

Franklin realised that effective teaching occurs when one involves the learner in his or her own education. We all have had memorable learning experiences when our teachers presented us with learning material or activity that was more germane to our jobs and activities. Yet scant attention has been paid to the teaching of the interpretation of lung function tests. In contrast to the vast number of books on ECG interpretation, try finding a decent book of PFT interpretation!

This book is exceptional and singular. The book is divided into eight chapters. Five of the chapters cover the five standard pulmonary function tests widely used by most lung function laboratories worldwide. However, three of the chapters deal with, first, a general approach to interpretation of lung function tests and then their report writing. The latter is the most helpful treatment I have ever seen on the topic. Next, there is a complete chapter devoted to test quality. Lastly, and perhaps uniquely, is Chapter 8 devoted to unusual test results that cause difficulties in interpretation, for example, patients with borderline results. Again, this is totally unique material.

However, the best part of this book is the number and quality of the case studies, and the best part of these is the presence of complete interpretations. Oh, what I would have given to have this book the first day I sat down with a stack of PFT results! If you spent the time on the cases, then you would make Ben Franklin proud. So take a deep breath and turn the page!

Charles G. Irvin, Ph.D.

University of Vermont

Burlington, Vermont

The lung is a highly complex organ whose access is difficult. Detection of abnormalities is largely dependent on measuring indices of lung function and imaging, other methods require invasive procedures such as bronchoscopy and tissue biopsy. Understanding how an organ with so many dichotomous components works to maintain the life-giving oxygenation and rid the body of carbon dioxide has been an enormous challenge. However, huge progress has been made in establishing structure–function relationships of the lung as an integrated complex organ and its implications when these are affected by a disease leading to an informative list of tests that can precisely identify diagnoses.

However, as with any test, interpretation depends on a clear understanding of lung physiology in health and disease, limitations of surrogate markers reflecting function and the possible pitfalls of over-interpretation. Although there have been many publications that deal with various aspects of this journey, there has not been a resource that enables the clinicians to easily interpret lung function measures in their entirety.

Brigitte Borg, Bruce Thompson and Robyn O'Hehir have achieved this remarkably well in their practical book Interpreting Lung Function Tests: A Step-by-Step Guide by explaining how the different tests of lung function are optimally undertaken, their implications for disease diagnosis and, importantly, how results should be reported, their clinical interpretation and limitations. A particularly valuable resource provided by this unique publication is a series of well-illustrated cases illustrating how far the tests can be interpreted to aid in diagnosis and evolve over the life course.

The book is presented in an easily accessible format making it essential reading for all those delivering an effective pulmonary function service and respiratory physicians who utilise these tests for patient benefit. Such a concise and easily readable book will be of great value to those who both undertake and utilise lung function testing, especially those in training.

Stephen T Holgate CBE, DSc, MD, FRCP, FRCPath, FMed Sci.

Faculty of Medicine

Southampton University, UK

Preface

In the healthcare setting, the purpose of performing a lung function test is to provide information to assist clinical decision-making and management strategies. The current expectation is that those working in the field of respiratory medicine will be able to interpret physiological measurements of lung function. The inspiration for this book arose from our local need for a resource to educate our advanced trainee physicians specialising in respiratory medicine in interpretation and reporting of lung function.

What started as a local guideline developed into a book as the guideline was expanded to include the many aspects and considerations in reporting common lung function tests. Illustrative cases were also incorporated to close the gap between theory and practice in interpretation and report writing.

The aims of this book are as follows:

To provide a teaching/reference tool for writing reports for lung function tests routinely performed in adults in clinical practice.

To provide the reader with the skill to interpret and write a concise and informative report.

To provide a uniform report format that can be used by multiple personnel reporting lung function tests within a service to promote consistency in reporting style.

There are many different tests of respiratory function, and it was not our objective to cover them all in this practical book. We have included the tests that are routinely performed in lung function laboratories, namely Spirometry, Static Lung Volumes, Gas Transfer Factor, Bronchial Provocation Tests, and Tests of Respiratory Muscle Strength. Similarly, we have chosen to focus on the lung function assessment of adults although some of the concepts equally apply to paediatrics.

We have utilised published literature to inform the interpretation strategies suggested in this book. In cases where published data are unavailable, we have formed interpretative strategies based on expert opinion.

Assumptions

The assessment of lung function is multifaceted. This book is not intended to be a technical manual on test performance or quality assurance nor a compendium of respiratory pathophysiology. In order to interpret lung function assessments, however, knowledge of these aspects is required and it is assumed that those using this book:

have a general understanding of respiratory physiology related to lung function assessment;

recognise and understand the standard parameters of lung function measurement (e.g. FEV1, TLC);

understand the importance of appropriately chosen reference values and the limitations of reference sets.

To keep it simple, the cases in Chapters 2 to 6 assume the following:

Testing equipment used in the assessment of lung function has been properly maintained, calibrated and is part of a regular quality assurance programme