Richard Johnston

CPET Test Interpretation, Part 4: Interpretation and Summary

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After having gone through the descriptive checklists for ventilatory, gas exchange and circulatory limitations the reason(s) for a patient’s exercise limitation, if any, should be reasonably clear. However, one of the first questions that should be asked when reading an exercise test is what was the purpose of the test?

  • Maximum safe exercise capacity for Pulmonary Rehab?
  • Rule in/rule out exercise-induced bronchospasm?
  • Pre-operative assessment?
  • Dyspnea of uncertain etiology?
  • What is the primary limitation to exercise (pulmonary or cardiac)?
  • Is deconditioning suspected?

The interpretation and summary should address these concerns.

The descriptions checklist is the main groundwork for the actual interpretation and any abnormal findings there may signal the need for specific comments. The interpretation should start by indicating whether or not the patient’s exercise capacity was normal and then should indicate the presence or absence of any limitations.

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2019 ATS/ERS Spirometry Standards

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The 2019 ATS/ERS Spirometry Standards were recently released. The standards are open-access and can be downloaded without charge from the October 15th issue of the American Journal of Respiratory and Critical Care Medicine. Supplements are available from the same web page.

The 2019 Spirometry Standards have been extensively re-organized with numerous updates. Notably, a number of sections that were previously discussed in the 2005 General Considerations for Lung Function Testing have been updated and included in the 2019 Spirometry Standards. Also notably, a number of stand-alone spirometry tests, including the Flow-Volume Loop, PEF and MVV are not included in the 2019 Standards.

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CPET Test Interpretation, Part 1: Ventilatory response

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I’ve always found interpreting CPET tests to be one of the more interesting (and enjoyable) things I’ve done. Interpreting a CPET test is both more difficult and easier than interpreting regular PFTs. More difficult because there are a lot more parameters involved and easier because determining test adequacy and the primary cause(s) of an exercise … Read more

Sharing opinions with Paul Enright

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Dr. Paul Enright is a well-known name in the field of Pulmonary Function testing. He is the lead author or co-author of over a hundred articles and has served on many of the ATS/ERS standards committees. Introduction: We both retired in southern Arizona and live a couple of towns apart from each other. We have … Read more

FEV1 and VC should be measured separately

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The FEV1 and VC both provide quite different information about a patient’s lungs. Unfortunately, spirometry as it is currently practiced is optimized towards generating an accurate FEV1 more than an accurate VC. This is partly due to limitations in the maneuver itself and partly due to the lack of accurate end-of-test criteria for an adequate … Read more

Infection Control

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The issue of infection control has been a topic of a couple of discussions I’ve had lately. In particular, it was reported to me that a PFT lab had come under fire from a Joint Commission inspector who did not believe that filter mouthpieces were adequate and that “patient valves and circuits need to be … Read more