Value of spirometry in detecting volume restriction in interstitial lung disease patients - Spirometry in interstitial lung diseases

Background: Restriction is a typical functional abnormality in interstitial lung disease (ILD) patients, but is not always present, especially in the early stage of the disease. The greater reduction of vital capacity (VC; % pred.) than total lung capacity (TLC; % pred.) is regarded as a typical pattern of lung function disturbances in ILD patients. Study Objectives: To explore the diagnostic value of spirometry in a detection restrictive pattern the relative volume loss assessed by TLC and VC in large series of patients with a diagnosis of ILD referred for lung function tests was evaluated. Methods: Retrospective, cross-sectional analysis of pulmonary function data was done. The sample consisted of 1,173 patients with the diagnosis of different interstitial lung diseases investigated during a period of 5 years. Only patients without airway obstruction (normal FEV1%VC) were included. In all cases spirometry and whole body plethysmography were performed by experienced staff using MasterLab-'Jaeger' equipment according to ERS standards. Reference values according to ERS guidelines were applied. Results: The mean value of TLC expressed as % pred. was significantly (p < 0.001) lower than VC in all patients (93.7 +/- 18.6 vs. 98.0 +/- 21.4% pred.). The frequency of abnormal (lowered) TLC results was also higher than lowered VC (22.8 vs. 17.8%). Sensitivity of VC reached 69.3% and the positive predictive value was 88.5% in detecting volume restriction as compared to TLC measurement. Conclusion: The relative loss of TLC was greater than VC in our large group of patients. Measurement of TLC should be part of functional assessment of ILD patients, irrespective of whether they present or do not present a restrictive pattern in spirometry. Copyright (C) 2004 S. Karger AG, Basel.