Predicting reduced TLC in patients with low FVC and a normal or elevated FEV1/FVC ratio.
OBJECTIVE
To use clinical and spirometry findings in order to distinguish between the restrictive and nonspecific patterns of pulmonary function test results in patients with low FVC and a normal or elevated FEV1/FVC ratio.


METHODS
We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a "true" restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC).


RESULTS
In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was >or= 90%. In males, an FVC <or= 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC <or= 50% of predicted. A difference of >or= 0% between the FEV1% and the FVC% had a PPV for restriction of 89.5%. After performing logistic regression, we developed a point scale for predicting the restrictive pattern.


CONCLUSIONS
In many patients with reduced FEV1, reduced FVC, and a normal FEV1/FVC ratio, the restrictive pattern can be identified with confidence through the use of an algorithm that takes the clinical diagnosis and certain spirometry measurements into account.
D'Aquino
Luiz Carlos
LC
Faculdade de Medicina, Universidade Regional de Joinville, Joinville, SC, Brasil.
Rodrigues
Sílvia Carla Sousa
SC
Barros
João Adriano de
JA
Rubin
Adalberto Sperb
AS
Rosário Filho
Nelson Augusto
NA
Pereira
Carlos Alberto de Castro
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D013147:Spirometry / Q000379:methods / Q000592:standards*; D014797:Vital Capacity / Q000502:physiology*; D055815:Young Adult