ERS/ATS technical standard on interpretive strategies for routine lung function tests.

Background: Appropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiological determinants of test results into functional classifications and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society (ATS) and European Respiratory Society (ERS) jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standards for PFT interpretation.
Methods: This technical standards document was developed by an international joint Task Force, appointed by the ERS/ATS with multidisciplinary expertise in conducting and interpreting PFTs and developing international standards. A comprehensive literature review was conducted and published evidence was reviewed.
Results: Recommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments.
Conclusions: Interpretation of PFTs must be complemented with clinical expertise and consideration of the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.
Competing Interests: Conflict of interest: S. Stanojevic reports grants, support for travel from the European Respiratory Society and was the Co-Chair of the Global Lung Function Initiative for the European Respiratory Society; and additionally acted on the Pulmonary Function Testing Proficiency committee for the American Thoracic Society, all outside the submitted work. Conflict of interest: D.A. Kaminsky reports speaker fees from MGC Diagnostics, Inc. and honoraria from UpToDate, Inc., outside the submitted work. Conflict of interest: M.R. Miller has nothing to disclose. Conflict of interest: B. Thompson reports grants from the NHMRC; consulting fees from 4D Medical and Chiesi; lecture honoraria from 4D Medical, Chiesi and Mundipharma; and reports past academic work with the Global Lung Function Initiative for the European Respiratory Society, outside the submitted work. Conflict of interest: A. Aliverti reports patents on Forced Oscillation Technique from Philips and patents on Opto-Electronic Plethysmography from BTS Bioengineering, outside the submitted work. Conflict of interest: I. Barjaktarevic has nothing to disclose. Conflict of interest: B.G. Cooper acted as Co-Chair of the Global Lung Function Initiative at the European Respiratory Society, outside the submitted work. Conflict of interest: B. Culver has nothing to disclose. Conflict of interest: E. Derom has nothing to disclose. Conflict of interest: G.L. Hall was former Co-Chair of the Global Lung Function Initiative and reports previous academic and leadership work with the Global Lung Function Initiative, both with the European Respiratory Society, outside the submitted work. Conflict of interest: T.S. Hallstrand reports research grants from the NIH (NHLBI, NIAID), outside the submitted work. Conflict of interest: J.D. Leuppi reports grants from the Swiss National Science Foundation (SNF 160072 and 185592) and Swiss Personalised Health Network (SPHN 2018DR108); and has also received unrestricted grants from AstraZeneca AG Switzerland, Boehringer Ingelheim GmbH Switzerland, GSK AG Switzerland and Novartis AG Switzerland, outside the submitted work. Conflict of interest: N. MacIntyre reports consulting fees from Vyaire, outside the submitted work. Conflict of interest: M. McCormack reports royalties for authorship for PFT chapters from UpToDate; consulting fees related to PFT quality and reading from Aridis, outside the submitted work. Conflict of interest: M. Rosenfeld has nothing to disclose. Conflict of interest: E.R. Swenson has nothing to disclose.
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