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Extra info for Evidence-Based Respiratory Medicine (Evidence-Based Medicine)
In these diseases, the FEV1,VC, FVC, PEF and FEV1/FVC (or FEV1/VC) ratio are commonly reduced. 2 Spirometry is used, often in conjunction with lung volumes,to classify abnormal ventilatory defects into one of three categories (see Table 1): 1 Obstructive ventilatory defect: characterized by a reduced capacity to ventilate the lungs due to airﬂow limitation. Typically,the FEV1,FEV1/FVC ratio and PEF are reduced,and there is a concavity towards the volume axis of the expiratory ﬂow volume curve. 2 Restrictive ventilatory defect: characterized by loss of lung volume in the absence of airﬂow limitation.
54 TLC provides an absolute measure of the degree of hyperinﬂation. An increased FRC in the presence of normal TLC provides a measure of the degree of functional hyperinﬂation. In the absence of neuromuscular disease or a stiff chest wall and in the presence of airﬂow limitation, an increased RV and RV/TLC ratio can provide information about effective gas trapping due to poorly ventilated lung regions or premature and excessive airway narrowing during the expiratory manoeuvre. The difference between VC and FVC and between Lung function testing TLC and VA can provide information about airway closure and the degree of effective gas trapping and non-uniformity of ventilation.
Similarly, in children, one-ﬁfth had airﬂow limitation as determined by a low FEV1/FVC ratio, whereas approximately half had mild disease on the basis of a reduced FEF25–75%. 42,44 Thus, given the disparity between subjective symptoms and objective lung function, it is likely that, by including spirometry as part of the treatment process, there may be real differences in subsequent outcomes such as symptoms and emergency department presentations. 45 Furthermore, knowledge of parameters that reﬂect asthma severity, over and above simple clinical parameters such as symptom frequency and bronchodilator use, is beneﬁcial for managing asthma.