Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital , Falls Church, VA, USA.
Pulmonary Function Testing and Clinical Trials Consultant , Rochester, MN, USA.
Expert Rev Respir Med. 2021 Feb;15(2):175-181. doi: 10.1080/17476348.2020.1816831. Epub 2020 Sep 28.
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.
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.
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.
用力肺活量（FVC）下降可预测特发性肺纤维化（IPF）患者的死亡率，并且已被用作临床试验终点来定义疾病进展。在测量准确性和可变性存在不确定性的情况下，如何在真实世界环境中解释个体 IPF 患者的 FVC 发现尚未得到很好的确定。
本文重点介绍了在临床中使用 FVC 监测 IPF 患者疾病进展时所面临的挑战和局限性。肺量计检查无创、相对简单且价格低廉。FVC 测量可提供 IPF 患者随时间推移的趋势证据。在临床中使用 FVC 时，必须考虑到几个重要的挑战和局限性，包括就诊间变异性、对患者努力的依赖、不一致的质量控制、准确性限制以及合并症和预测试因素的影响。最近的研究表明，家庭肺量计设备可能有助于更频繁地收集数据，并可能显示更准确的趋势。
在临床中测量 FVC 下降在监测 IPF 患者的疾病进展方面具有重要作用，但应与 FVC 一起考虑其他疾病进展的衡量指标，以促进有关疾病管理的决策。
