I used to think that spirometry and diffusion capacity tests were hard and that lung volumes were easy. That may have been true in terms of getting patients to do the tests but I’ve long since come to the conclusion that it is easier to assess the quality of spirometry and diffusing capacity tests and know whether you have reasonably accurate results than it is to do this for lung volumes regardless of which lung volume measurement technique you use.

The MIP test is used to assess the strength of the inspiratory muscles and is commonly performed in patients with neuromuscular disease. Results however, are often low because the sensation involved in performing a maximal inspiratory effort against an occluded airway is unpleasant and because the MIP requires coordination, cooperation and motivation to be performed correctly. In addition patients with neuromuscular disease frequently lack the muscular strength necessary to grip the mouthpiece and can therefore leak around it. For these reasons although a normal value will rule out significant muscular weakness, a low value can be difficult to interpret.

The distance attained during a 6-minute walk (6MWD) has been used extensively to assess the functional capacity of patients with a variety of diseases and conditions. It is relatively easy to perform and requires a minimum of equipment. Changes in 6MWD before and after rehabilitation, surgery, or medications are often used to signal the success or failure of these therapies. For the last dozen years every drug and device research study my lab has been involved with has used the 6MWD as one of their outcomes.

The late 1800’s through the early 1900’s saw the birth and spread of amusement parks, penny arcades and nickelodeons. Although this was due in part to an increase in the number of people living in cities and to an increase in disposable income, it was also in large part due to the invention of mass transit. In a bid to increase ridership many railroad, trolley and subway lines built or sponsored amusement parks.

A writer posed an interesting question on the AARC Diagnostics forum several weeks ago and that was how to market their PFT Lab. I don’t think they got much of a response but I have been thinking about this since then. I think that any good lab manager wants to see their lab succeed and grow. I’ve always felt that pulmonary function testing is an essential component of preventive care but that despite this PFT Labs are underutilized. In order to market your PFT Lab effectively you need to understand your customers and target your message accordingly. You also need to understand that you can’t get something for nothing. Marketing requires that you expend resources, whether it is just your time or includes lab budget money, in order to get any payback.

The beginning of pulmonary function testing can best be dated to 1846 when John Hutchinson invented the spirometer. Although similar devices had been used by previous scientists he turned it into a precision instrument and approached the study of lung function systematically. His work inspired innumerable other researchers and inventors, and within a few years improved versions of his spirometer were appearing across Europe and America. By my count within twenty years there were at least four other methods for measuring expiratory volume (at least one of which is still in use) had been applied to a new generation of spirometers.

The Slow Vital Capacity (SVC) maneuver is usually performed as part of lung volume measurements. It is not unusual for the SVC to be larger than the FVC, particularly in patients with airway obstruction. This can have a bearing on the FEV1/FVC ratio and in fact the ATS-ERS recommendations for PFT interpretation say that the largest vital capacity value regardless of which test it comes from should be used to calculate the FEV1/VC ratio. When I review a full panel of tests (FVC, lung volumes, DLCO) I always check to see if the SVC or IVC (from the DLCO test) are larger than the FVC and then re-calculate the FEV1/FVC ratio and its percent predicted if they are. Test results that at first glance look normal will instead show airway obstruction often enough when this has been done that the time spent going through this process is worthwhile.

My PFT Lab has recently been asked by several doctor’s offices and clinics to advise them on the purchase of an office spirometry system. I am not a fan of office spirometry because I think the test quality is often low. Office spirometry is usually performed by poorly trained office staff using poorly maintained equipment and under these conditions quality is going to suffer. Despite my misgivings the reality is that office spirometry is not going away and in fact its use is probably expanding.

Patients that have problems with oxygenation at sea level are going to have even more problems at higher elevations where the barometric pressure and oxygen partial pressure are lower. During commercial aircraft travel the cabin pressure is required by U.S. Federal regulations to be pressurized to at least 565 mm Hg which is the equivalent of 8000 feet altitude. It has been reported that most airliners are pressurized to an equivalent altitude of between 5000 and 8000 feet but this will depend on both the airplane and the airline in question.

Although the authors of the Global Lung Function Initiative (GLFI) study acknowledge the effect of height on their reference equations the range and distribution of heights in its study populations was not included in the report. This was a similar problem for the NHANESIII reference equations since the height range was never reported within the text of the original report however it did include scatter graphs showing the range of heights. These graphs imply the height range was 162 to 194 cm (64” to 76”) for caucasian males and 145 to 180 cm (57” to 71”) for caucasian females. Using the extremes of these height ranges it is interesting to see how the GLFI reference equations compare to the NHANESIII reference equations.