AMERICAN THORACIC SOCIETY DOCUMENTS

Name: Xxxxxxxxxx, Yyyyyyyyy Referred by: Dr. G. Practitioner

Sample Pulmonary ID: 111 222 333 Date of test: 2017-Feb-20 14:30
Function Laboratory Sex: Male Reason: Short of breath
Birth date: 1965-Aug-04 SpO2 at rest: 99%
Anytown, Anywhere Age: 51 Height: 69 in; 175 cm
555-345-6789 Ethnicity: Caucasian Weight: 202 lb; 91.8 kg
pftests@[Link]
Smoking: Ex-smoker BMI: 30.0 kg/m2

SPIROMETRY
Pre-Bronchodilator Post-Bronchodilator
Best LLN z-score %Pred Best z-score %Pred Change %Chng
FVC (L) 3.90 3.70 –1.34 82% 4.70 –0.09 99% 600 mL 20%
FEV1 (L) 2.02 2.91 –3.78 54% 2.61 –2.21 70% 590 mL 29%
FEV1/FVC 0.52 0.68 –3.54 0.55 –3.35
FET (s) 10.3 11.2
Reference values: GLI 2012 Test quality: Pre: FEV1 - A, FVC - A; Post: FEV1 - A, FVC - B

Pre-Bronchodilator LLN predicted

8
FVC
*
**
FEV1
6 FEV1/FVC

z-score –5 –4 –3 –2 –1 0 1 2 3
4
Post-Bronchodilator LLN predicted
Flow (L/s)

2 FVC
*
* *
FEV1
FEV1/FVC
0
z-score –5 –4 –3 –2 –1 0 1 2 3

–2 6
pre
Volume (L)

post
–4 4

–6 2
–1 0 1 2 3 4 5
0
Volume (L)
–1 1 3 5 7 9 11 13 15
Time (s)

SLOW VITAL CAPACITY (Pre-Bronchodilator) 8

7
Best LLN ULN z-score %Pred 6

VC (L) 4.17 4.0 6.0 –1.61 83% 5

Volume [L]

4
IC (L) 2.76 2.4 3.9 87% 3
FEV1/VC 0.48 0.68 –3.86 2

Reference values: VC - Gutierrez 2004; FEV1/VC – GLI 2012 1

0
–1
–14 –12–10 –8 –6 –4 –2 0 2 4 6 8 10 12 14 16
Time [s]

TECHNICIAN COMMENTS: No medications Moderately severe, partially reversible airflow obstruction.

in past 24 hr. 400 mcg albuterol given for
reversibility testing.

Dr. P. Pulmonologist 2017-Feb-24

Figure 1. Example of a single-page report for pre- and postbronchodilator spirometry testing. The linear graphic is divided in units of 1 SD, with the
LLN shown at a z-score of 21.64. This simplified report is suitable for the medical record or referring physician, but the test interpreter should have
access to the data and curves of all acceptable spirometry efforts. FET = forced expiratory time; GLI = Global Lung Function Initiative; IC = inspiratory
capacity; LLN = lower limit of normal; SpO2 = oxygen saturation as measured by pulse oximetry; ULN = upper limit of normal; VC = vital capacity.

1466 American Journal of Respiratory and Critical Care Medicine Volume 196 Number 11 | December 1 2017
AMERICAN THORACIC SOCIETY DOCUMENTS

MULTI-BREATH NITROGEN WASHOUT (Post-Bronchodilator) 80 8 ULN

N2 concentration [%]
Result LLN ULN z-score %Pred 7
TLC mb (L) 5.95 5.8 8.5 –1.45 83% 6 LLN

Volume (L)
VC (L) 4.05 4.0 6.0 –1.61 81% 10 5
ICmb (L) 3.27 88% IC ULN
4
FRC mb (L) 2.68 2.2 4.6 –1.03 78%
3
ERV (L) 0.78 61% ERV LLN
ULN
1 2
RV mb (L) 1.90 1.4 2.9 –0.49 89% RV LLN
0.5 1
RV/TLC (%) 32%
0 20 40 0
Reference values: Gutierrez 2004; Test quality: QA met
Volume [L] Pred Result TLC FRC RV

PLETHYSMOGRAPHY (Post-Bronchodilator) Pressure 9 ULN

Result LLN ULN z-score %Pred 15 8

TLC pl (L) 8.68 6.6 9.3 0.90 109% 10 7 IC LLN

VC (L) 4.79 4.5 6.5 –1.15 87% 6

Volume (L)
3.42 5
IC pl (L) 2.7 4.1 100% 5 ULN
FRC pl (L) 5.26 2.7 5.0 2.00 137% 0 4 ERV
ERV (L) 1.29 1.3 2.1 76%
–5 3 LLN ULN
RV pl (L) 3.89 1.7 3.2 3.07 160%
–10 2 LLN
RV/TLC 45% 27% 45% RV
Vtg (L) 5.92 3.1 5.5 138% 1
–15
Reference values: Gutierrez 2004; Test quality: QA met 20 mL 0
Pred Result TLC FRC RV
Figure 2. Examples of the recommended reporting format for lung volume testing in one subject by multibreath nitrogen (N2) washout and in another subject
by plethysmography. The N2 washout is plotted on a log scale, resulting in a nearly linear profile. On this plethysmography tracing the box pressure has been
converted to volume to show the thoracic excursions at a scale of 20 ml per division. The bar graphs on the right show the predicted and observed values of RV, FRC,
and TLC, and the arrows show these results in relation to their normal range on vertical linear scales. The graphs depict RV in blue, ERV in orange, IC in gray, and
normal range in green. (See Figures E1 and E2 in the online supplement for examples of consolidated reports for full pulmonary function tests.) ERV = expiratory
reserve volume; IC = inspiratory capacity; LLN = lower limit of normal; mb = multibreath; pl = plethysmography; QA = quality assurance; RV = residual volume; TLC =
total lung capacity; ULN = upper limit of normal; VC = vital capacity; Vtg = thoracic gas volume.

When diffusion capacity is measured, a value along with the reference source, a (KCO) is optional, but the term DL/VA (the
comparison of total lung capacity measured quality assurance indication, and the ratio of diffusing capacity to alveolar
by both techniques can be a useful quality conditions of the test, in this case post- volume) should be avoided as it is
control measure or an indication of bronchodilator. The barometric pressure commonly misunderstood. If measured, the
maldistribution. should be given, as well as stating whether hemoglobin should be shown as well as the
the values were corrected to standard adjusted predicted values for both DLCO
Diffusing Capacity (Transfer Factor) barometric pressure (particularly important and KCO. The display shows the washout of
The display (Figure 3) gives the relevant for laboratories at altitude) (6). Reporting both carbon monoxide and the tracer gas
values, the LLN, and the percent predicted the carbon monoxide transfer coefficient and the sample volume. The sample volume

DIFFUSING CAPACITY (Post-Bronchodilator)

Result LLN z-score %Pred
D LCO (mL / min / mmHg) 13.4
D LCO (at standard PB) 13.0 23.4 –4.55 42%
D LCO (pred adj Hb 13.8 g/dL) 13.0 53%
VA (L) 5.83 5.75 –1.55 82%
TLCsb (L) 6.01
CH4
VI/VC (%) 85%
CO
K CO (mL / min / mmHg / L) 2.23 3.25 –3.47 52%
Reference values: GLI 2017; Test quality: one grade A test; PB: 721 mmHg
LLN predicted
10 12 14 16
D LCO
VA * *
Time (s)

K CO
z-score –5 –4 * –3 –2 –1 0 1 2 3

Figure 3. Example of the recommended reporting format for the single-breath diffusing capacity test. The 2017 Technical Standard for DLCO (6) requires that
the CO and tracer gas concentrations be graphed versus exhaled volume, rather than versus time as shown here. When hemoglobin is measured, it should be shown
on the report with a note indicating whether the predicted value has been adjusted for this. CH4 = methane (tracer gas); DLCO = diffusing capacity of the lung for
carbon monoxide; GLI = Global Lung Function Initiative; KCO = carbon monoxide transfer coefficient; LLN = lower limit of normal; PB = barometric pressure; pred adj
Hb = hemoglobin adjusted for predicted value; sb = single breath; TLC = total lung capacity; VI/Vc = inspired volume/vital capacity.

American Thoracic Society Documents 1467