The role of the pulmonary function test and the exercise test for assessing impairment/disability in patients with chronic airflow obstruction

Abstract

Background: In 1980, WHO made a definition in which the term 'impairment' as applied to the respiratory system is used to describe loss of lung function, 'disability' the resulting diminution in exercise capacity. The measurement of pulmonary function during exercise would give us information about overall functional capacity and respiratory performance that would be lacking in tests performed at rest. We conducted this study to investigate the role of resting pulmonary function test and exercise test for assessing impairment/disability in patients with chronic airflow obstruction (CAO). Method: We studied 19 patients with CAO. The spirometry and body plethysmograph were performed in stable condition. And then patients performed a progressive incremental exercise test to a symptom-limited maximum using cycle ergometer. Patients were divided in two groups, severe and non-severe impairment, according to the resting PFTs and compared to each other. A patient was considered to be severely impaired if FVC < 50%, FEV1 < 40% or FEV1/FVC < 40%. Results: 1) The airway obstruction and hypoxemia of severe impairment group were more severe and exercise performance was markedly reduced comparing to non-severe impairment group. 2) The severe impairment group showed ventilatory during exercise test and the limiting symptoms were dyspnea in 9/10 patients. 3) The impairment and disability of the patients with tuberculous destructed lung were most marked in patients with CAO. 4) The FEV1 was the most prevalent criterion for the determination of severe impairment based on resting PFTs and was the valuable best correlated to VO2max (r = 0.81, p < 0.001). 5) The sensitivity of exercise limits for predicting severe disability according to resting PFTs was 80% and specificity 89%. Conclusion: In patients with severe CAO, FEV1 is a good predictive of exercise performance and impairment measured by resting PFTs can predict a disability by exercise test.