Evaluating Volume-Time Curves
8 8
6 6
Volume (L)
Volume (L)
4 4
2 2
0 0
–1 0 1 2 3 4 5 6 7 8 –1 0 1 2 3 4 5 6 7 8
Time (seconds) Time (seconds)
A B
Figure 2. Volume-time curve showing (A) normal plateau of the volume of air expired at one or two seconds (total
expiration lasts at least six seconds), and (B) no plateau; the volume continues to increase throughout expiration (this
spirometry result should be interpreted with caution).
Determining the Validity of Pulmonary Function Tests
Predicted Best % of predicted 1 2 3
FVC (L) 3.66 3.04 83 2.93 3.04 2.94
FEV1 (L) 2.96 2.12 72 2.09 2.12 2.02
FEV1/FVC (%) 83 70 84 71 70 69
FEF25%-75% 3.36 1.36 40 1.44 1.36 1.23
(L per second)
PEF 6.65 4.71 71 5.07 4.71 4.67
Trial 1 Trial 2 Trial 3
Flow Flow Flow
(L per second) (L per second) (L per second)
Expiration
Inspiration
Volume (L) Volume (L) Volume (L)
Figure 3. The FEV1 and FVC measurements are within 0.2 L of each other during the two best efforts. Consistent,
reproducible effort and flow loops confirm validity. (FEF25%-75% = forced expiratory flow at 25% to 75% of FVC;
FEV1 = forced expiratory volume in one second; FVC = forced vital capacity; PEF = peak expiratory flow.)
Step 2: Determine If the FVC Is Low patient has an obstructive defect and a restrictive pattern),
The physician must determine if the FVC is less than the or pure obstructive lung disease with air trapping. Table 2
LLN for adults or less than 80% of predicted for those five summarizes the first two steps of PFT interpretation.1-3,10,11
to 18 years of age, indicating a restrictive pattern.3,10,11 The
LLN can be determined using the calculator at http://hank Step 3: Confirm the Restrictive Pattern
consulting.com/RefCal.html. A restrictive pattern can If the patient’s initial PFT results indicate a restrictive
indicate restrictive lung disease, a mixed pattern (if a pattern or a mixed pattern that is not corrected with
362 American Family Physician www.aafp.org/afp Volume 89, Number 5 ◆
March 1, 2014
