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Semin Respir Crit Care Med 2005; 26(2): 246-252
DOI: 10.1055/s-2005-869543
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Pulmonary Function in COPD

Christopher B. Cooper1 , 2
  • 1Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
  • 2Departments of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Further Information

Publication History

Publication Date:
27 April 2005 (online)

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ABSTRACT

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.

KEYWORDS

Pulmonary function testing - COPD - screening spirometry - body plethysmography - impulse oscillometry - preoperative assessment

REFERENCES

  • 1 Pauwels R A, Buist A S, Calverley P M, Jenkins C R, Hurd S S. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.  Am J Respir Crit Care Med. 2001;  163 1256-1276
    CrossrefPubMedSearch in Google Scholar
  • 2 Clausen J L, Coates A L, Quanjer P H. Measurement of lung volumes in humans: review and recommendations from an ATS/ERS workshop.  Eur Respir J. 1997;  10 1205-1206
    CrossrefPubMedSearch in Google Scholar
  • 3 National Institute for Clinical Excellence (NICE) . Chronic obstructive pulmonary disease: national clinical guidelines for management of chronic obstructive pulmonary disease in adults in primary and secondary care.  Thorax. 2004;  59(suppl 1)
    PubMedSearch in Google Scholar
  • 4 Fitzgerald J M, Grunfeld A, Pare P D et al.. The clinical efficacy of combination nebulized anticholinergic and adrenergic bronchodilators vs nebulized adrenergic bronchodilator alone in acute asthma. Canadian Combivent Study Group.  Chest. 1997;  111 311-315
    PubMedSearch in Google Scholar
  • 5 Fletcher C, Peto R. The natural history of chronic airflow obstruction.  BMJ. 1977;  1 1645-1648
    CrossrefPubMedSearch in Google Scholar
  • 6 Sandford A J, Chagani T, Weir T D, Connett J E, Anthonisen N R, Pare P D. Susceptibility genes for rapid decline of lung function in the lung health study.  Am J Respir Crit Care Med. 2001;  163 469-473
    CrossrefPubMedSearch in Google Scholar
  • 7 Scanlon P D, Connett J E, Waller L A, Altose M D, Bailey W C, Buist A S. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study.  Am J Respir Crit Care Med. 2000;  161(2 Pt 1) 381-390
    CrossrefPubMedSearch in Google Scholar
  • 8 Donaldson G C, Seemungal T AR, Bhowmik A, Wedzicha J A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
    CrossrefPubMedSearch in Google Scholar
  • 9 Cooper C B, Tashkin D P. Recent developments in inhaled therapy in stable chronic obstructive pulmonary disease.  BMJ. 2005;  330 640-644
    CrossrefPubMedSearch in Google Scholar
  • 10 O'Donnell D E. Ventilatory limitations in chronic obstructive pulmonary disease.  Med Sci Sports Exerc. 2001;  33(suppl 7) S647-S655
    CrossrefPubMedSearch in Google Scholar
  • 11 Chrystyn H, Mulley B A, Peake M D. Dose response relation to oral theophylline in severe chronic obstructive airways disease.  BMJ. 1988;  297 1506-1510
    PubMedSearch in Google Scholar
  • 12 Newton M F, O'Donnell D E, Forkert L. Response of lung volumes to inhaled salbutamol in a large population of patients with severe hyperinflation.  Chest. 2002;  121 1042-1050
    CrossrefPubMedSearch in Google Scholar
  • 13 Belman M J, Brooks L R, Ross D J, Mohsenifar Z. Variability of breathlessness measurement in patients with chronic obstructive pulmonary disease.  Chest. 1991;  99 566-571
    PubMedSearch in Google Scholar
  • 14 Celli B, ZuWallack R, Wang S, Kesten S. Improvement in resting inspiratory capacity and hyperinflation with tiotropium in COPD patients with increased static lung volumes.  Chest. 2003;  124 1743-1748
    CrossrefPubMedSearch in Google Scholar
  • 15 O'Donnell D E, Lam M, Webb K A. Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  160 542-549
    PubMedSearch in Google Scholar
  • 16 O'Donnell D E, Fluge T, Gerken F et al.. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD.  Eur Respir J. 2004;  23 832-840
    PubMedSearch in Google Scholar
  • 17 O'Donnell D E, Voduc N, Fitzpatrick M, Webb K A. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease.  Eur Respir J. 2004;  24 86-94
    CrossrefPubMedSearch in Google Scholar
  • 18 Marques-Magellanes J A, Storer T W, Cooper C B. Treadmill exercise duration and dyspnea recovery time in chronic obstructive pulmonary disease: effects of oxygen breathing and repeated testing.  Respir Med. 1998;  92 735-738
    PubMedSearch in Google Scholar
  • 19 Marin J M, Carrizo S J, Gascon M, Sanchez A, Gallego B, Celli B R. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  163 1395-1399
    PubMedSearch in Google Scholar
  • 20 American Thoracic Society . Standardization of spirometry: 1994 update.  Am J Respir Crit Care Med. 1995;  152 1107-1136
    Search in Google Scholar
  • 21 Enright R L, Connett J E, Bailey W C. The FEV1/FEV6 predicts lung function decline in adult smokers.  Respir Med. 2002;  96 444-449
    PubMedSearch in Google Scholar
  • 22 Dykstra B J, Scanlon P D, Kester M M, Beck K C, Enright P L. Lung volumes in 4774 patients with obstructive lung disease.  Chest. 1999;  115 68-74
    CrossrefPubMedSearch in Google Scholar
  • 23 American Thoracic Society . Single-breath carbon monoxide diffusing capacity (transfer factor): recommendations for a standard technique-1995 update.  Am J Respir Crit Care Med. 1995;  152 2185-2198
    PubMedSearch in Google Scholar
  • 24 Dellaca R L, Santus P, Aliverti A et al.. Detection of expiratory flow limitation in COPD using the forced oscillation technique.  Eur Respir J. 2004;  23 232-240
    CrossrefPubMedSearch in Google Scholar
  • 25 DuBois A B, Brody A W, Lewis D H, Burgess Jr B F. Oscillation mechanics of lungs and chest in man.  J Appl Physiol. 1956;  8 587-594
    CrossrefPubMedSearch in Google Scholar
  • 26 Goldman M D. Clinical application of forced oscillation.  Pulm Pharmacol Ther. 2001;  14 341-350
    PubMedSearch in Google Scholar
  • 27 Hellinckx J, Cauberghs M, De Boeck K, Demedts M. Evaluation of impulse oscillation system: comparison with forced oscillation technique and body plethysmography.  Eur Respir J. 2001;  18 564-570
    CrossrefPubMedSearch in Google Scholar
  • 28 Braun S R, McKenzie W N, Copeland C, Knight L, Ellersieck M. A comparison of the effect of ipratropium and albuterol in the treatment of chronic obstructive airway disease.  Arch Intern Med. 1989;  149 544-547
    CrossrefPubMedSearch in Google Scholar
  • 29 Donohue J. A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol.  Chest. 2002;  122 47-55
    CrossrefPubMedSearch in Google Scholar
  • 30 Brusasco V, Hodder R, Miravitlles M, Korducki L, Towse L, Kesten S. Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD.  Thorax. 2003;  58 399-404
    CrossrefPubMedSearch in Google Scholar
  • 31 James A. Airway remodeling in asthma.  Curr Opin Pulm Med. 2005;  11 1-6
    CrossrefPubMedSearch in Google Scholar
  • 32 Gross N J. Anticholinergic agents in COPD.  Chest. 1987;  91(5 Suppl) 52S-57S
    PubMedSearch in Google Scholar
  • 33 COMBIVENT Inhalation Aerosol Study Group . In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: an 85-day multicenter trial.  Chest. 1994;  105 1411-1419
    PubMedSearch in Google Scholar
  • 34 Harpole Jr D H, DeCamp Jr M M, Daley J et al.. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection.  J Thorac Cardiovasc Surg. 1999;  117 969-979
    CrossrefPubMedSearch in Google Scholar
  • 35 Mohr D N, Lavender R C. Preoperative pulmonary evaluation: identifying patients at increased risk for complications.  Postgrad Med. 1996;  100 241-244 247-248 251-252 , passim
    PubMedSearch in Google Scholar
  • 36 National Emphysema Treatment Trial Research Group . Patients at high risk of death after lung-volume-reduction surgery.  N Engl J Med. 2001;  345 1075-1083
    CrossrefPubMedSearch in Google Scholar
  • 37 Cooper C B, Storer T W. Exercise Testing and Interpretation. A Practical Approach Cambridge; Cambridge University Press 2001
    Search in Google Scholar
  • 38 Jackson C V. Preoperative pulmonary evaluation.  Arch Intern Med. 1988;  148 2120-2127
    CrossrefPubMedSearch in Google Scholar
  • 39 Coultas D B, Mapel D, Gagnon R, Lydick E. The health impact of undiagnosed airflow obstruction in a national sample of United States adults.  Am J Respir Crit Care Med. 2001;  164 372-377
    PubMedSearch in Google Scholar
  • 40 Enright P L, Kaminsky D A. Strategies for screening for chronic obstructive pulmonary disease.  Respir Care. 2003;  48 1194-1201
    PubMedSearch in Google Scholar
  • 41 Gorecka D, Bednarek M, Nowinski A, Puscinska E, Goljan-Geremek A, Zielinski J. Diagnosis of airflow limitation combined with smoking cessation advice increases stop-smoking rate.  Chest. 2003;  123 1916-1923
    CrossrefPubMedSearch in Google Scholar
  • 42 Jansson S A, Andersson F, Borg S, Ericsson A, Jonsson E, Lundback B. Costs of COPD in Sweden according to disease severity.  Chest. 2002;  122 1994-2002
    CrossrefPubMedSearch in Google Scholar
  • 43 Petty T L, Doherty D E. National Lung Health Education Program. The National Lung Health Education Program: roots, mission, future directions.  Respir Care. 2004;  49 678-683
    PubMedSearch in Google Scholar
  • 44 Stratelis G, Jakobsson P, Molstad S, Zetterstrom O. Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years.  Br J Gen Pract. 2004;  54 201-206
    PubMedSearch in Google Scholar

Christopher B CooperM.D. 

David Geffen School of Medicine at UCLA, 10833 Le Conte Ave.

37-131 CHS, Los Angeles, CA 90095-1690

Email: ccooper@mednet.ucla.edu