Pulmonary Function Laboratory, Elliot Health System, Manchester, New Hampshire.
Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont.
Respir Care. 2023 Jul;68(7):889-913. doi: 10.4187/respcare.10757.
Pulmonary function testing (PFT) has a long and rich history in the definition, diagnosis, and management of COPD. For decades, spirometry has been regarded as the standard for diagnosing COPD; however, numerous studies have shown that COPD symptoms, pathology, and associated poor outcomes can occur, despite normal spirometry. Diffusing capacity and imaging studies have called into question the need for spirometry to put the "O" (obstruction) in COPD. The role of exercise testing and the ability of PFTs to phenotype COPD are reviewed. Although PFTs play an important role in diagnosis, treatment decisions are primarily determined by symptom intensity and exacerbation history. Although a seminal study positioned FEV as the primary predictor of survival, numerous studies have shown that tests other than spirometry are superior predictors of mortality. In years past, using spirometry to screen for COPD was promulgated; however, this only seems appropriate for individuals who are symptomatic and at risk for developing COPD.
肺功能测试（PFT）在 COPD 的定义、诊断和管理中具有悠久而丰富的历史。数十年来，肺活量测定法一直被视为诊断 COPD 的标准；然而，许多研究表明，尽管肺活量测定法正常，但仍可能出现 COPD 症状、病理学和相关不良结局。扩散能力和影像学研究对肺活量测定法在 COPD 中“阻塞”的必要性提出了质疑。本文回顾了运动测试的作用以及 PFT 对 COPD 表型的作用。虽然 PFT 在诊断中起重要作用，但治疗决策主要取决于症状强度和加重史。尽管一项开创性的研究将 FEV 定位为生存的主要预测因子，但许多研究表明，除了肺活量测定法之外，其他测试是更好的死亡率预测因子。过去几年，使用肺活量测定法筛查 COPD 已得到推广；然而，这似乎只适用于有症状且有发展为 COPD 风险的个体。
