Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada.
Division of Respirology, Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Chest. 2020 Oct;158(4):1629-1643. doi: 10.1016/j.chest.2020.04.064. Epub 2020 May 16.
The lung function laboratory frequently provides relevant information to the practice of pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has been complicated more recently by temporal changes in demographic characteristics (higher life expectancy), anthropometric attributes (increased obesity prevalence), and the surge of polypharmacy in a sedentary population with multiple chronic degenerative diseases. In this narrative review, we concisely discuss some key challenges to test interpretation that have been affected by these epidemiologic shifts: (a) the confounding effects of advanced age and severe obesity, (b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or COPD), (c) the importance of considering the diffusing capacity of the lung for carbon monoxide (Dlco)/"accessible" alveolar volume (carbon monoxide transfer coefficient) in association with Dlco to uncover the causes of impaired gas exchange, and (d) the modern role of the pulmonary function laboratory (including cardiopulmonary exercise testing) in the investigation of undetermined dyspnea. Following a Bayesian perspective, we suggest interpretative algorithms that consider the pretest probability of abnormalities as indicated by additional clinical information. We, therefore, adopt a pragmatic approach to help the practicing pulmonologist to apply the information provided by the lung function laboratory to the care of individual patients.
肺功能实验室经常为肺病学实践提供相关信息。然而，最近由于人口特征（预期寿命延长）、人体测量属性（肥胖患病率增加）以及久坐不动的人群中多药治疗的激增，同时患有多种慢性退行性疾病，肺功能和运动测试的临床解释变得更加复杂。在这篇叙述性综述中，我们简要讨论了一些受到这些流行病学变化影响的测试解释的关键挑战：（a）高龄和严重肥胖的混杂影响，（b）阻塞性疾病（包括哮喘和/或 COPD）诊断的当代争议，（c）考虑一氧化碳弥散量（Dlco）/“可及”肺泡容积（一氧化碳传递系数）与 Dlco 相关联以揭示气体交换受损原因的重要性，以及（d）肺功能实验室（包括心肺运动测试）在不明原因呼吸困难调查中的现代作用。基于贝叶斯观点，我们提出了考虑附加临床信息指示的异常先验概率的解释算法。因此，我们采用实用的方法来帮助临床肺病学家将肺功能实验室提供的信息应用于个体患者的护理。
