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resources:pulm:interpreting_pfts [2023/12/20 14:25] – [Table] adminresources:pulm:interpreting_pfts [2024/03/08 18:32] (current) – [Assessing Restriction] admin
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 |[[https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf | 2010 GOLD Spirometry Guide]]| |[[https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf | 2010 GOLD Spirometry Guide]]|
 |[[https://doi.org/10.1183/13993003.01499-2021 | 2022 ERS/ATS Interpretive Strategies for PFTs]]| |[[https://doi.org/10.1183/13993003.01499-2021 | 2022 ERS/ATS Interpretive Strategies for PFTs]]|
 +
 +====== Interpretation Position ======
 +==== Why I use GOLD Criteria ====
 +
 +At UMMC, PFTs do report LLN and reference value (pop mean?) but not percentiles or z scores.
 +
 +One can back-calculate the SD using $\sigma = \frac{LLN - ref}{-1.65}$ (this assumed LLN on our reports corresponds to 5th percentile).
 +
 +Once $\sigma$ is known for the each value (e.g., $\sigma_{FVC} \neq \sigma_{FEV1} \neq \sigma_{RV}$), you could then use $z = \frac{PT_{value} - ref}{\sigma}$ and refer to the tables below to grade severity.
 +
 +Given the complexity of this, using ERS/ATS for diagnosing and grading abnormalities is not possible.
 +
 +Therefore, I use GOLD criteria.
 +
  
 ====== Step-by-Step to Interpreting PFTs ====== ====== Step-by-Step to Interpreting PFTs ======
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 === GOLD Criteria === === GOLD Criteria ===
-^ Grade ^ FEV1 Percent Predicted ^ Severity ^ +[[https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf | Source]] 
-|1| ≥80%|Mild| +^ Grade  ^ FEV1 Percent Predicted  ^ Severity     ^ 
-|2|50% − 79%|Moderate| +| 1      | ≥80%                    | Mild         | 
-|3|30% − 49%|Severe| +| 2      | 50% − 79%               | Moderate     | 
-|4|<30%|Very Severe|+| 3      | 30% − 49%               | Severe       | 
 +| 4      | <30% or <50% with CHRF  | Very Severe  |
  
 ==== Bronchodilator Response ==== ==== Bronchodilator Response ====
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     - $\Delta FEV1_{volume} >200 mL$     - $\Delta FEV1_{volume} >200 mL$
  
 +=== GOLD Definition ===
 +  - Required:
 +    - $BDR >12%$
 +    - $\Delta FEV1_{volume} \geq 200 mL$
 +
 +  - Calculation 
 +    - $ BDR = \frac{FEV1_{postBD} - FEV1_{preBD}}{FEV1_{preBD}}$
 +    - **NOTE: this differs from ERS/ATS calculation**
 +
 +==== Methacholine Challenge ====
 +[[https://doi.org/10.1183/13993003.01526-2016 | Source, ERS 2017]]
 +
 +===Response Categorization ===
 +{{:resources:pulm:methacholine_response.png?900|}}
 +
 +=== Testing Protocol ===
 +{{:resources:pulm:methacholine_challenge.png?600|}}
 ===== DLCO Severity===== ===== DLCO Severity=====
 === ERS / ATS Definition === === ERS / ATS Definition ===
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 {{:resources:pulm:ats_restriction.png?600|}} {{:resources:pulm:ats_restriction.png?600|}}
  
-^ TLC Percent Predicted ^ Severity ^+[[https://erj.ersjournals.com/content/erj/60/1/2101499.full.pdf | Source]] 
 +^ Grade  ^ FEV1 z score ^ Severity            ^ 
 +| NA     | −1.65 to −2.5 | Mild                | 
 +| NA     | −2.51 to −4.0 | Moderate            | 
 +| NA     | <−4.1 | Severe            
 + 
 +=== GOLD Definition === 
 +  - Required: 
 +    - FVC <80% predicted 
 + 
 +^TLC Percent Predicted^Severity^
 |>70% | Mild | |>70% | Mild |
 |50%-69% | Moderate | |50%-69% | Moderate |
resources/pulm/interpreting_pfts.1703082318.txt.gz · Last modified: 2023/12/20 14:25 by admin

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