The 'Non-Specific' Pulmonary Function Test: Longitudinal Follow up and Outcomes on 1284 Patients.

Iyer, VN; Parker, KO; Schroeder, Torben V.; Re, Hyatt; Scanlon, PD

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a6060

Cited by 32 publications

(47 citation statements)

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“…Based on these facts, we elected not to include DLCO in our analysis. 25 when FVC was ,LLN with FEV 1 /FVC $ LLN and TLC $80% predicted, was present after normal, obstructive, restrictive, and mixed patterns defined by the Pellegrino scheme had been applied. 23 Details of the classification scheme are given in Figure 2.…”

Section: Markers Of Abnormal Pulmonary Functionmentioning

confidence: 99%

“…Of the 430 participants who had a PFT performed, only 43% (188 of 430) had NT-pro brain natriuretic peptide levels measured. Further, among the individuals who had a PFT and died, only 23% 23 Hyatt el al, 24 and Iyer et al 25 ) *The nonspecific pattern was defined based on Hyatt el al 24 and Iyer et al 25 : FVC% predicted ,LLN with FEV 1 /FVC% predicted $LLN and TLC % predicted $80%.…”

Section: Other Predictors Of Mortalitymentioning

confidence: 99%

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Low forced expiratory volume is associated with earlier death in sickle cell anemia

Kassim

Payne

Rodeghier³

et al. 2015

Blood

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• Among adults with SCA, decreased FEV 1 percent predicted was associated with earlier death.• Obstructive and restrictive pulmonary function patterns do not predict earlier death in adults with SCA.Pulmonary complications result in mortality in adults with sickle cell anemia (SCA). We tested the hypothesis that abnormal pulmonary function was associated with earlier death. A prospective cohort of adults with SCA, followed in the Cooperative Study for Sickle Cell Disease, was constructed using the first pulmonary function test at >21 years of age. Spirometry measures: forced expiratory volume in 1 second (FEV 1 ), forced vital capacity, and total lung capacity were categorized based on age, gender, height, and race. Pulmonary function patterns were categorized based on the American Thoracic Society guidelines using both spirometry and lung volumes. A cohort of 430 adults with SCA, mean age 32.6 6 9.5 (range, 21.0-67.8) years at time of first pulmonary function test, and a median follow-up of 5.5 years, was evaluated. A total of 63 deaths occurred. At baseline, 47% had normal, 29% restrictive, 8% obstructive, 2% mixed, and 14% nonspecific lung function patterns. In the final multivariable model, lower FEV 1 percent predicted was associated with increased hazard ratio of death (HR per % predicted 1.02; 95% confidence interval [CI] 1.00-1.04; P 5 .037), as was older age (HR 1.07; 95% CI 1.04-1.10; P < .001), male sex (HR 2.09; 95% CI 1.20-3.65; P 5 .010), higher lactate dehydrogenase levels (HR per mg/dL 1.002; 95% CI 1.00-1.003; P 5 .015), and higher acute chest syndrome incidence rate (HR per event/year 10.4; 95% CI 3.11-34.8; P < .001). Presence of obstructive (HR 1.18; 95% CI: 0.44-3.20; P 5 .740) and restrictive (HR 1.31; 95% CI: 0.64-2.32; P 5 .557) pulmonary function patterns were not associated with earlier death. Understanding the pathophysiology of a low FEV 1 percent predicted in individuals with SCA is warranted, enabling early intervention for those at risk. (Blood. 2015;126(13):1544-1550

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Section: Markers Of Abnormal Pulmonary Functionmentioning

confidence: 99%

Section: Other Predictors Of Mortalitymentioning

confidence: 99%

Low forced expiratory volume is associated with earlier death in sickle cell anemia

Kassim

Payne

Rodeghier³

et al. 2015

Blood

View full text Add to dashboard Cite

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“…The study investigators postulate a volume de-recruitment mechanism to explain the relationship between FVC, RV, and TLC in the subjects with airway involvement. In a follow-up study, Iyer et al 22 looked at a larger cohort of patients with the nonspecific pattern who were tested on more than one occasion. They observed that the non-specific pattern persisted in 64% of the subjects, with equal numbers converting to either an obstructive or a restrictive pattern (15% and 16%, respectively).…”

Section: Is a Low Tlc (Ie Restriction) A Useful Measurement?mentioning

confidence: 99%

What Is the Clinical Value of Lung Volumes?

Ruppel

2012

Respir Care

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Lung volumes are considered part of a complete pulmonary function test, but their value for enhancing clinical decision making is unknown. Unlike spirometry and diffusing capacity of the lung for carbon monoxide (D LCO ), which do contribute to confirming or excluding a diagnosis, there are few clear indications when lung volumes are discriminatory. Confirming "restriction" when vital capacity (VC) or FVC is reduced is perhaps the most important. A restrictive pattern can have many etiologies, and clinicians often use VC or FVC as a primary index of lung volume. This makes "physiologic" sense because, in healthy subjects, and in patients with true restriction, VC comprises most of the total lung capacity (TLC). Mixed obstruction-restriction and the nonspecific pattern (ie, reduced FVC and FEV 1 , normal FEV 1 /FVC and TLC) require measuring TLC to confirm the underlying physiology. In obesity, VC and TLC may remain within normal limits, but functional residual capacity (FRC) can exponentially decrease. Increased lung volumes, particularly residual volume (RV), are commonly observed in airway obstruction. TLC may be normal, but is frequently increased in the late stages of COPD. Hyperinflation and air-trapping are terms commonly used to reflect these changes, but are not well standardized. The variability of lung volumes related to degree of obstruction suggests that measuring gas-trapping may be needed to monitor therapy. Changes in inspiratory capacity, RV, or FRC may be important gauges of response to bronchodilators or other hyperinflation-reducing therapies. How lung volumes are measured may be important, especially in patients who have moderate or severe airway obstruction. Body plethysmography is often considered more accurate than gas dilution methods in the presence of obstruction. However, the differences between techniques are not completely understood. Newer approaches such as computed tomography, although not suitable for routine testing, may help to delineate the true underlying physiology.

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“…15 Experts have not decided whether to classify this as "restriction" or as "obstruction." A 3-year follow-up study of 1,284 patients with the nonspecific pattern found no significant change in FEV 1 in two thirds, 12 while the other third developed a low TLC (restriction) or a low FEV 1 /FVC (obstruction). Many patients exposed to the fumes, dust, and gases at Ground Zero (after the World Trade Center attacks) who had asthma-like symptoms (suggesting reactive airways dysfunction) had "spirometric restriction" with a normal FEV 1 / FVC.…”

Section: The Nonspecific Patternmentioning

confidence: 97%

PFT Interpretive Strategies: American Thoracic Society/ European Respiratory Society 2005 Guideline Gaps

Miller

Enright

2012

Respir Care

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SummaryAll pulmonologists, including those recently completing training, should be competent in critically evaluating and interpreting pulmonary function tests (PFTs). In addition, some authorities recommend that respiratory therapists learn to provide preliminary PFT interpretations for the medical directors of PFT labs. The 2005 American Thoracic Society/European Respiratory Society guidelines for interpreting PFTs lack recommendations for the best reference equations for lung volumes and diffusing capacity of the lung for carbon monoxide (D LCO ), and lack reference equations for non-whites. The pre-test probability of lung disease should be determined using a short questionnaire. The "nonspecific pattern" occurs in about 15% of patients referred to a PFT lab, but it has many clinical correlates and the course is usually benign. Less common PFT patterns and those resulting from comorbid conditions (such as obesity, respiratory muscle weakness, or heart failure) are not discussed by the guidelines. More than half of patients with interstitial lung disease have a normal ratio of D LCO /V A (alveolar volume), and many have a normal total lung capacity.

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The 'Non-Specific' Pulmonary Function Test: Longitudinal Follow up and Outcomes on 1284 Patients.

Cited by 32 publications

References 0 publications

Low forced expiratory volume is associated with earlier death in sickle cell anemia

Low forced expiratory volume is associated with earlier death in sickle cell anemia

What Is the Clinical Value of Lung Volumes?

PFT Interpretive Strategies: American Thoracic Society/ European Respiratory Society 2005 Guideline Gaps

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