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52 GUIDELINES FOR EXERCISE TESTING • www.acsm.org
TABLE 3.4. INDICATIONS FOR SPIROMETRY
A. INDICATIONS FOR SPIROMETRY
Diagnosis
To evaluate symptoms, signs, or abnormal laboratory tests
To measure the effect of disease on pulmonary function
To screen individuals at risk of having pulmonary disease
To assess preoperative risk
To assess prognosis
To assess health status before beginning strenuous physical activity programs
Monitoring
To assess therapeutic intervention
To describe the course of diseases that affect lung function
To monitor people exposed to injurious agents
To monitor for adverse reactions to drugs with known pulmonary toxicity
Disability/Impairment Evaluations
To assess patients as part of a rehabilitation program
To assess risks as part of an insurance evaluation
To assess individuals for legal reasons
Public Health
Epidemiologic surveys
Derivation of reference equations
Clinical research
B. THE GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE SPIROMETRIC
CLASSIFICATION OF COPD SEVERITY BASED ON POSTBRONCHODILATOR FEV 1
Stage I Mild FEV 1 /FVC 0.70
FEV 1 80% of predicted
Stage II Moderate FEV 1 /FVC 0.70
50% FEV 1 80% predicted
Stage III Severe FEV 1 /FVC 0.70
30% FEV 1 50% predicted
Stage IV Very severe FEV 1 /FVC 0.70
FEV 1 30% predicted or FEV 1 50%
predicted plus chronic respiratory failure
C. THE AMERICAN THORACIC SOCIETY AND EUROPEAN RESPIRATORY SOCIETY
CLASSIFICATION OF SEVERITY OF ANY SPIROMETRIC ABNORMALITY BASED ON FEV 1
Degree of Severity
FEV 1 % Predicted
Mild
Less than the LLN but 70
Moderate 60–69
Moderately severe 50–59
Severe 35–49
Very severe 35
COPD, chronic obstructive pulmonary disease; FEV 1, forced expiratory volume in one second; FVC, forced vital capacity;
respiratory failure, arterial partial pressure of oxygen (PaO 2 ) 8.0 kPa (60 mm Hg) with or without arterial partial
pressure of CO 2 (PaO 2 ) 6.7 kPa (50 mm Hg) while breathing air at sea level; LLN, lower limit of normal.
Modified from Pauwels RA, Buist AS, Calverly PM, et al. Global strategy for the diagnosis, management, and prevention
of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Workshop summary. Am J Respir Crit Care Med. 2001;163:1256–76. Available from: http//www.goldcopd.com (last
major revision, November 2006); Pellegrino R, Viegi G, Enright P, et al. Interpretive strategies for lung function tests.
ATS/ERS Task Force: standardisation of lung function testing. Eur Respir J. 2005;26:948–68.