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Pulmonary Function TestingCase 3 AnswerA 60 year-old man presents to his primary care provider with complaints of increasing dyspnea on exertion. He has a 40 pack-year history of smoking and is retired following a career as a building contractor. His pulmonary function testing is as follows:
His flow volume loops is as follows: Case 3 InterpretationThis patient has markedly abnormal spirometry. The FVC is only 41% predicted while the FEV1 is only 25% predicted, well below the lower limit of normal of 80% predicted. In addition, the FEV1/FVC ratio is markedly reduced. The combination of the low FEV1, FVC and reduced FEV1/FVC ratio is consistent with a diagnosis of airflow obstruction. With an FEV1 of 25% predicted, this would be classified as “severe” airflow obstruction. The patient also meets criteria for reversible airflow obstruction as both the FEV1 and FVC improve by over 200 ml and 12% following administration of a bronchodilator. In addition to these abnormalities on spirometry, the patient has a markedly elevated residual volume (RV), a finding that is indicative of air-trapping. The total lung capacity (TLC) is somewhat elevated at 117% predicted but it is still shy of the 120% predicted level used to define hyperinflation.
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