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• W3024633939 abstract "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. 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. Interpretation of Diffusing CapacityCHESTVol. 159Issue 6PreviewInterpretation of pulmonary function tests is important and is addressed in CHEST (October 2020) by Neder et al.1 However, their description of lung diffusing capacity interpretation is convoluted. A much simpler, intuitive interpretation of diffusing capacity is based on the effect of lung volume on the diffusing capacity of the lung for carbon monoxide (Dlco) and carbon monoxide transfer coefficient (Kco) (Dlco/volume of distribution of the tracer gas during Dlco maneuver-predicted dead space [VA]). Full-Text PDF ResponseCHESTVol. 159Issue 6PreviewWe thank Dr Johnson for his interest in our simplified, clinically oriented update on pulmonary function testing interpretation.1 We proposed an algorithm for the interpretation of a low lung diffusing capacity for carbon monoxide (Dlco) that considers the accessible “alveolar” volume (VA) that is derived from the single-breath helium dilution volume and its relationship with total lung capacity (TLC). In healthy subjects, VA approaches TLC in such a way that the VA/TLC ratio is consistently ≥0.8, regardless of age, sex, height, or weight. Full-Text PDF" @default.
• W3024633939 created "2020-05-21" @default.
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• W3024633939 date "2020-10-01" @default.
• W3024633939 modified "2023-10-18" @default.
• W3024633939 title "The Lung Function Laboratory to Assist Clinical Decision-making in Pulmonology" @default.
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• W3024633939 doi "https://doi.org/10.1016/j.chest.2020.04.064" @default.
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