interpreting pulmonary function tests（解释肺功能测试）（7页）.docVIP

Interpreting Pulmonary Function Tests Devan Kansagara, M.D. WEEK 9: 02/28 – 03/04/05 Learning Objectives: Understand the benefits of early spirometry use in minimally symptomatic smokers in primary care practice Be able to understand the role of test quality when interpreting pulmonary function tests Be able to differentiate between obstructive and restrictive patterns on pulmonary function testing Understand how to define reversible airway obstruction CASE ONE: Mr. Tar E. Lungs is your 47-year-old patient who is seeing you for his annual physical. Other than occasional GERD, he has no past medical history. He admits to smoking one pack of cigarettes per day for the last 27 years. At each annual visit you have mentioned he should quit and he always says “yeah, yeah doc I know – I think this is gonna be my year.” He has no complaints on review of systems. Physical examination is unremarkable. Questions: Would you order spirometry for Mr. Lungs? Why or why not? The case for ordering PFTs in our dyspneic patients is fairly obvious to most providers. However, we are less likely to order PFTs for our minimally symptomatic smokers. But there is some rationale for checking spirometry in these patients. In fact, many offices are now equipped with office-based spirometry which can aid in the early detection of COPD. The National Lung Health Education Program recommends that primary care providers should check spirometry in patients, over the age of 44, who smoke (current or quit during the previous year). And, of course, smoking patients with respiratory symptoms, regardless of age, should be considered for spirometry assessment. The rationale is as follows: If not detected early, COPD can result in substantial morbidity and mortality There is treatment that is more effective if begun in the early stages of COPD before patients become symptomatic. The most important treatment is smoking cessation. Smokers with borderline to moderate ai