The aim of this study was to determine the added value of measuring the forced expiratory flow at 25–75% of forced vital capacity (FVC) (FEF_25–75%) and flow when 75% of FVC has been exhaled (FEF_75%) over and above the measurement of the forced expiratory volume in 1 s (FEV₁), FVC and FEV₁/FVC ratio.We used spirometric measurements of FEV₁, FVC and FEF_25–75%from 11 654 white males and 11 113 white females, aged 3–94 years, routinely tested in the pulmonary function laboratories of four tertiary hospitals. FEF_75%was available in 8254 males and 7407 females. Predicted values and lower limits of normal, defined as the fifth percentile, were calculated for FEV₁, FVC, FEV₁/FVC ratio, FEF_25–75%and FEF_75%using prediction equations from the Global Lung Function Initiative.There was very little discordance in classifying test results. FEF_25–75%and FEF_75%were below the normal range in only 2.75% and 1.29% of cases, respectively, whereas FEV₁, FVC and FEV₁/FVC ratio were within normal limits. Airways obstruction went undetected by FEF_25–75%in 2.9% of cases and by FEF_75%in 12.3% of cases.Maximum mid-expiratory flow and flow towards the end of the forced expiratory manoeuvre do not contribute usefully to clinical decision making over and above information from FEV₁, FVC and FEV₁/FVC ratio.

The aim of this study was to determine the diagnostic and interpretative consequences of adopting the Global Lungs Initiative (GLI) 2012 spirometric prediction equations.We assessed spirometric records from 17 572 subjects (49.5% females), aged 18–85 years, from hospitals in Australia and Poland.We calculated predicted forced expiratory volume in 1 s (FEV₁), forced expiratory volume (FVC), FEV₁/FVC and lower limits of normal (LLN) using European Community for Steel and Coal (ECSC), National Health and Nutrition Examination Survey (NHANES) III and GLI 2012 equations. Obstruction was defined as FEV₁/FVCLLN and FVC<LLN. Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher was defined as FEV₁/FVC <0.70 and FEV₁20% underdiagnosis of airway obstruction up to the age of 55 years and to 16–23% overdiagnosis in older subjects. GLI 2012 equations increase the prevalence of a “restrictive spirometric pattern” compared to ECSC but decrease it compared to NHANES.

The objective of this study was to redesign the current grading of obstructive lung disease so that it is clinically relevant and free of biases related to age, height, sex and ethnic group.Spirometric records from 17 880 subjects (50.4% female) from hospitals in Australia and Poland, and 21 191 records (53.0% female) from two epidemiological studies (age range 18–95 years) were analysed. We adopted the American Thoracic Society(ATS)/European Respiratory Society (ERS) criteria for airways obstruction based on an forced expiratory volume in 1 s (FEV₁)/(forced) vital capacity ((F)VC) ratio below the fifth percentile and graded the severity of pulmonary function impairment using z-scores for FEV₁, which signify how many standard deviations a result is from the mean predicted value.Using the lower limit of normal for FEV₁/(F)VC and z-scores for FEV₁of -2, -2.5, -3 and -4 to delineate severity grades of airflow limitation leads to close agreement with ATS/ERS severity classifications and removes age, sex and height related bias.The new classification system is simple, easily memorised and clinically valid. It retains previously established associations with clinical outcomes and avoids biases due to the use of per cent predicted FEV₁. Combined with the Global Lung Function prediction equations it provides a worldwide diagnostic standard, free of bias due to age, height, sex and ethnic group.

Sarcoidosis is a systemic granulomatous disease with predominant manifestation in the lungs, often presenting as interstitial lung disease. Pulmonary function abnormalities in sarcoidosis include restriction of lung volumes, reduction in diffusing capacity of the lung for carbon monoxide (D_L,CO), reduced static lung compliance (C_L,s) and airway obstruction. The aim of the present study was to assess various lung function indices, includingC_L,sandD_L,CO, as markers of functional abnormality in sarcoidosis patients.Results from 830 consecutive patients referred for lung function tests with a diagnosis of sarcoidosis (223 in stage I, 486 in stage II and 121 in stage III) were retreospectively analysed. The mean±sdage of the patients was 40±11 yrs; 18% were active smokers and 24% were former smokers.Normal total lung capacity was found in 772 (93%) patients. Of these cases, 24.5% had a lowC_L,sand 21.5% had a lowD_L,CO. At least one abnormality was observed in 39.3% of these patients, whereas, in restrictive patients, this figure was 88%. Airway obstruction was present in 11.7% of cases.Lung volumes usually remain within the normal range and measurement of eitherC_L,sorD_L,COoften reveal impaired lung function in sarcoidosis patients, even when their lung volumes are still in the normal range; these two measurements provide complementary information.

Coronavirus disease 2019 (COVID-19) has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges and the emergence of different variants of SARS-CoV-2 have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance.This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond.Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups and alternative options to testing in hospitals.The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long-term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.

Introduction Sarcoidosis is a systemic granulomatous disease which predominantly affects the lungs, although granulomas can also involve all other organs, including the heart. Cardiac sarcoidosis (CS) may occur at any stage of the disease and may be the cause of sudden cardiac death, even in a previously asymptomatic patient. The aim of this study was to evaluate the incidence of CS in a large group of patients diagnosed or followed up due to sarcoidosis. Methods We performed a retrospective analysis of patients at our institution discharged with the final diagnosis “sarcoidosis” (ICD-10: D86) from January 2008 to October 2012. Only those with biopsy (from respiratory tract or lymph nodes) confirmed diagnosis of sarcoidosis were included. We then selected the subset of patients with cardiac involvement due to sarcoidosis confirmed by positive magnetic resonance imaging. Results The study covered 1375 consecutive sarcoidosis patients (51 % men), who were hospitalized during 5 years. Multiorgan disease was detected in 160 cases (11.7 %), and cardiac involvement was found in 64 patients (4.7 % of all), 70.3 % of whom were men. Twelve of those with CS were in stage I, 48 in stage II, and four in stage III. The odds ratio for having cardiac involvement in men compared to women was 2.3 (95 % CI 1.36–4.0, p = 0.002). Conclusions Cardiac involvement in sarcoidosis was diagnosed in the similar percentage as in previously published data but was significantly more frequently in men.