Lung volume + flow volume curve
EFFORT/圖形-- Obstructive -- Restrictive -- PEF
6sec--FEV1/FVC->FEV1--FVC(VC suggested by ATS/ERS)--TLC--Grading--PEF(可不評論)
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Quality control: >3acceptable test, variation<150ml, 吐氣>6 sec:
otherwise==>POOR EFFORT
Error code as below:
According to ATS 2005 Interpretation of pulmonary function test
Severity grading with FEV1(obstructive/restrictive)
| FEV1(%pred) | Severity |
| >70 | Mild |
| 60-70 | Moderate |
| 50-60 | Moderately severe |
| 35-50 | Severe |
| <35 | Very severe |
Interpretative strategies for lung function tests
2016Interpretation
PFT_CME
PFT BLOG
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ATS criteria(cited from Cleaveland Clinic DOS CME 2011)
old version 建議判讀流程：
照著obstruction/restriction defect分別grading
Obstructive Severity |
Restrictive Severity |
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THE PULMONARY FUNCTION TEST SHOWS NORMAL VENTILATORY FUNCTION.
THE PULMONARY FUNCTION TEST SHOWS NORMAL VENTILATORY FUNCTION WITH SUBOPTIMAL PEF.
THE PULMONARY FUNCTION TEST SHOWS MILD/MODERATE/SEVERE OBSTRUCTIVE VENTILATORY IMPAIRMENT.
THE PULMONARY FUNCTION TEST SHOWS MILD/MODERATE/SEVERE RESTRICTIVE VENTILATORY IMPAIRMENT.
THE PULMONARY FUNCTION TEST SHOWS MILD OBSTRUCTIVE AND MILD RESTRICTIVE VENTILATORY IMPAIRMENT.
POOR EFFORT.
INADEQUATE EFFORT. (林限定)
THE PULMONARY FUNCTION TEST SHOWS ABNORMAL NONSPECIFIC VENTILATORY PATTERN.
About PEF:
**SUBOPTIMAL PEF在北榮胸腔部特別受到重視是因為肺功能室創立者蕭光明主任認為在FEV1和FVC正常的情況下可以偵測早期的異常如ASTHMA。*
*OBSTRUCTIVE和RESTRICTIVE VENTILATORY IMPAIRMENT皆會影響PEF，已經判讀成OBSTRUCTIVE或RESTRICTIVE VENTILATORY IMPAIRMENT時不必再提WITH SUBOPTIMAL PEF。
**蘇、周: 在NORMAL VENTILATORY FUNCTION的情況下不打WITH SUBOPTIMAL PEF
**其他老師如果PEF<80 %PRED都要打。
**若FVC的判讀被TLC修正時(見下一段第3點)，PEF不要判讀
About restrictive lung disease:
**在RESTRICTIVE VENTILATORY IMPAIRMENT的判讀方面，當FVC與TLC的結果不一致，都以TLC的結果為主，如果FVC小但TLC正常，理論上應判讀為ABNORMAL NONSPECIFIC VENTILATORY PATTERN(ATS的flowchart其實走到obstructive)，但是肺功能室創立者蕭光明主任不用這個打法，因此只能判讀為NORMAL VENTILATORY FUNCTION (WITH SUBOPTIMAL PEF)。
**蘇: 已經判為obstructive ventilatory impairment，要有TLC才能打restrictive ventilatory impairment
**林:個人比較相信FVC，但是與目前的共識不同。可以接受用TLC或FVC來判讀，但是打報告的人標準要統一。如果以TLC的結果來判讀，當TLC正常時，即使PEF<80 %PRED也不要打WITH SUBOPTIMAL PEF，理由是既然選擇不相信FLOW VOLUME CURVE的結果，PEF作為其中的一個DATA也不採信。
About poor effort:
**POOR EFFORT通常在報告中技術員會加註，如果技術員沒有直接判定POOR EFFORT，判讀者可根據圖形自行判定，林會將技術員沒有判但她覺得病人吹得不好的檢查判讀為INADEQUATE EFFORT。