The Lung Function Laboratory to Assist Clinical-Decision Making in Pulmonology: Evolving Challenges to an Old Issue.

The Lung Function Laboratory to Assist Clinical-Decision Making in Pulmonology: Evolving Challenges to an Old Issue. Chest. 2020 May 16;: Authors: Neder JA, Berton DC, O'Donnell DE Abstract The lung function laboratory frequently provides relevant information to the practice of Pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has more recently been complicated by temporal changes in demographics (higher life expectancy) and anthropometric attributes (increased obesity prevalence) and the surge of polypharmacy in a sedentary population suffering from multiple chronic-degenerative diseases. In this narrative review, we concisely discuss some key challenges to testing interpretation which have been impacted from these epidemiological shifts: a) the confounding effects of advanced age and severe obesity, b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or chronic obstructive pulmonary disease), c) the importance of considering the lung diffusing capacity for carbon monoxide (DLCO)/"accessible" alveolar volume (diffusing coefficient, KCO) in association with DLCO to uncover the cause(s) 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 which consider the pre-test prob...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research