Using forced vital capacity (FVC) in the clinic to monitor patients with idiopathic pulmonary fibrosis (IPF): pros and cons

Abstract

Introduction: Forced vital capacity (FVC) decline is predictive of mortality in patients with idiopathic pulmonary fibrosis (IPF) and has been used as a clinical trial endpoint to define disease progression. How to interpret FVC findings in an individual patient with IPF in the real-world setting amid uncertainty about the measurement accuracy and variability has not been well established. Areas covered: This review highlights the challenges and limitations of using FVC in the clinic to monitor disease progression in patients with IPF. Spirometry is noninvasive, relatively simple, and inexpensive. FVC measurements provide evidence for trends over time in patients with IPF. When using FVC in the clinic, several important challenges and limitations, including visit-to-visit variability, dependence on patient effort, inconsistent quality control, limitations on accuracy, and the influence of comorbidities and pretest factors, must be considered. Recent studies suggest the potential for home spirometry devices to facilitate more frequent collection of data and perhaps demonstrate more accurate trends. Expert opinion: Measuring FVC decline in the clinic has an important role in monitoring disease progression in patients with IPF, but additional measures of disease progression should be considered along with FVC to facilitate decision-making about disease management.

Clinical course and risk factors for development and progression of interstitial lung disease in primary Sjögren’s syndrome

“…Serial PFTs are a simple, non-invasive method for monitoring disease progression in patients with ILD. However, intra-patient visit-to-visit variability in FVC measurements over time and a number of other factors affecting FVC results, such as comorbidities and aging make it difficult to assess the progression of ILDs 8 , 9 . Therefore, clinicians should determine ILD progression based on comprehensive evaluations, including worsening respiratory symptoms, PFTs, and chest imaging findings.…”

Comparing the Inspiratory Capacity Measurements Obtained by Incentive Spirometry and Ultrasonic Spirography in the Early Postoperative Period in Cardiac Surgery Patients

“…В этой связи приходится ограничиваться спирометрией покоя, т. е. измерением волюметрических показателей, поскольку большинство этих пациентов выполнить нагрузочные пробы не в состоянии. По литературным данным, в большинстве научных исследований для оценки эффективности методик немедикаментозной респираторной физиотерапии используются портативные или стационарные спирографы с измерением форсированной жизненной емкости легких (ФЖЕЛ), объема форсированного выдоха в 1 сек (ОФВ₁), отношения ОФВ₁/ФЖЕЛ, общей емкости легких (ОЕЛ), пикового потока выдоха, среднего потока форсированного выдоха в течение средней по-ловины ФЖЕЛ и других показателей [25,26]. Однако, эти исследования проводили у пациентов терапевтического профиля, состояние которых по сравнению с кардиохирургическими больными было значительно легче, и у них отсутствовали болевой синдром и астенизация.…”

Home-Based Spirometry in Patients with Interstitial Lung Diseases: A Real-Life Pilot “FACT” Study from Serbia

“…As some ILDs have a progressive course, such as idiopathic pulmonary fibrosis (IPF), serial repetition of spirometry and obtaining forced vital capacity (FVC) values are of great importance in monitoring the progression of fibrosis in these patients, the response to the applied therapy, and the prediction of unfavorable outcomes from the disease, such as acute exacerbation and mortality [ 7 , 8 ]. Thus, it is not surprising that the majority of ILDs clinical trials use FVC as the primary endpoint [ 9 , 10 ]. As the disease progresses, the burden of symptoms increases significantly, making it more difficult for some patients to attend regular medical check-ups and spirometry evaluations.…”