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Clinical Investigations: PULMONARY FUNCTION TESTS |

A Spirometry-Based Algorithm To Direct Lung Function Testing in the Pulmonary Function Laboratory*

Christine A. Glady; Shawn D. Aaron; Mary Lunau; Jennifer Clinch; Robert E. Dales
Author and Funding Information

*From the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Correspondence to: Shawn D. Aaron, MD, Division of Respiratory Medicine, The Ottawa Hospital, General Campus, Room 1812F, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6; e-mail: saaron@ottawahospital.on.ca



Chest. 2003;123(6):1939-1946. doi:10.1378/chest.123.6.1939
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Objective: To design a spirometry-based algorithm to predict pulmonary restrictive impairment and reduce the number of patients undergoing unnecessary lung volume testing.

Design: Two prospective studies of 259 consecutive patients and 265 consecutive patients used to derive and validate the algorithm, respectively.

Setting: A pulmonary function laboratory of a tertiary care hospital.

Patients: Consecutive adults referred to the laboratory for lung volume measurements and spirometry.

Measurements: The sensitivity of the algorithm for predicting pulmonary restriction and the cost savings associated with its use.

Results: Total lung capacity correlated strongly with FVC (r = 0.66) and showed an inverse correlation with the FEV1/FVC ratio (r = − 0.41). According to the algorithm, only patients with an FVC < 85% of predicted and an FEV1/FVC ratio ≥ 55% required lung volume measurements following spirometry. The algorithm had a high sensitivity for predicting restriction and a high negative predictive value (NPV) for excluding restriction (sensitivity, 96%; NPV, 98%). The diagnostic properties of the algorithm were reproducible in the validation study. Application of the algorithm would eliminate the need for lung volume testing in 48 to 49% of patients referred to the pulmonary function test (PFT) laboratory, reducing costs by 33%.

Conclusions: A spirometry-based algorithm accurately excludes pulmonary restriction and reduces unnecessary lung volume testing in the PFT laboratory almost in half.

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