title: Grading the severity of obstruction in the presence of a restrictive ventilatory defect.
abstract: OBJECTIVE
  No recommendation currently exists for grading the severity of airway obstruction in the presence of additional restriction. The grading of airway obstruction is currently based on the FEV(1) (American Thoracic Society [ATS] recommendations), while prior recommendations by the Intermountain Thoracic Society (ITS) graded the severity of obstruction based on the FEV(1)/FVC ratio. The objective was to compare the grading of airway obstruction using the percent predicted FEV(1) (ATS) with a confidence interval-based system (ITS), with particular focus on pulmonary functions in patients having both airway obstructions and restrictions.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  A retrospective analysis of 21,499 patient pulmonary function tests (PFTs) was performed. The predicted values of Crapo and coworkers were used.
  
  
  RESULTS
  The distribution of the severity of the obstruction was compared using the ATS and ITS methods for PFTs with normal, increased, or decreased total lung capacity (TLC). Analysis was performed using the chi(2) method. Of the 21,499 PFTs that were analyzed, TLC was measured in 28% (5,962 PFTs). In this cohort, 44% (2,619 PFTs) gave evidence of obstruction. Of these, 147 PFTs demonstrated additional restriction. While the ATS criteria graded 133 of these PFTs (90%) as being severe, the ITS criteria graded only 4 PFTs (3%) as severe (the severity distribution between the methods was significantly different [p < 0.01]).
  
  
  CONCLUSIONS
  In view of the possible overestimation of the severity of obstruction in PFTs with concurrent restriction using the percentage of predicted FEV(1) values, consideration should be given to grading the severity of obstruction on the basis of the FEV(1)/FVC ratio in this specific subset of PFTs.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Room 6732, UCLA School of Medicine, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.balfed@csmc.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Balfe
authors.forename: Michael
authors.initials: M
authors.lastname: Lewis
authors.forename: Zab
authors.initials: Z
authors.lastname: Mohsenifar
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology; D012016:Reference Values; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013147:Spirometry; D014109:Total Lung Capacity; D014797:Vital Capacity