SPIROMETRY TEST RESULTS

I had two blood clots in January 2006.  In December 2007, prior to surgery, the surgeon requested an evaluation of my lungs as well as heart.  Below are the results of the spirometry test.  What is your interpretation? (Having difficulty telling "F's" from "E's)

SPIROMETRY                 PRE-BROCH                            POST-BRONCH

FVC                 2.71 3.66 74 3.08 84 13
FEV1                 1.79 2.90 62 2.06 84 15
FEV1/FVC    66    80 83    67 84   1
FEF 25%                 3.21 5.33 60 4.09 77 27
FEF 75%                 0.34 1.44 24 0.64 45 87
FEF 25-75%(L/see) 0.95 2.82 34 1.61 57 69
FEF Max (L/see) 5.27 6.89 76 552 80   5
FIVC                 2.85 3.06   7
FIF Max (L/sec) 4.54 4.95   9
MVV (L/min)    78    99 78
Expiratory Time (sec) 6.67 6.80   2

LUNG VOLUMES
SVC                 3.25 3.66   89
IC                 3.02 2.28         1.32
ERV                 0.23 1.38   16
TGV                 3.06 2.92 105
RV(PLETH) 2.83 1.84 154
TLC (Pleth) 6.08 5.20 117
RV/TLC(Pleth)(%)    47    35 133
Trapped gas

DIFFUSION
DLCOunc(ml/min/mmHg) 10.63 26.71 40
DLCOcor(ml/min/mmHg) 26.71
DL/VA(ml/min/mmHgL) 2.13 5.14 41
VA 4.99 5.20 96


I am a 51 year-old 304lb woman and I thank you so much for your help and for making this service available to those who otherwise would have no where else to turn...thank you again.'

[National Jewish Health]

These results are consistent with a moderate degree of reversible obstruction to air flow.  They demonstrate a 15% improvement in forced expiratory volume in first second of exhalation (FEV1), after bronchodilator, that is a significant bronchodilator effect as is most commonly seen with diseases characterized by reversible obstruction, most notably asthma.  These findings are consistent with the borderline elevation of total lung capacity (TLC).  The definite elevation of the residual volume (RV) of 154% and the RV/TLC ratio of 47% are indicative of “air trapping” as seen with both chronic obstructive pulmonary disease (COPD) and asthma.

There are a number of methods determining the carbon monoxide (CO) diffusion capacity.  Results must be corrected for reduced lung volumes, anemia, increased CO levels in cigarette smokers, and high altitude.  Reduced values are obtained when interstitial fibrosis is extensive or when the capillary surface is reduced by vascular obstruction or non-perfusion, such as pulmonary embolism or destroyed as with emphysema.  The diffusion capacity is usually, either normal or elevated with asthma.  This test requires careful technique and is subject to error.

Your diffusion capacity (DLCO), as listed, is significantly reduced when uncorrected and decreased when expressed with a correction for alveolar volume, which is predicted normal.  I question the validity of the DLCOcor of 26.71, exactly the same figure as the DLCOunc predicted (26.71) and inconsistency of some of the other lung volume data.  If the reduction in DLCO is correct, the most likely causes would be COPD and/or loss of pulmonary vascularity due to the blood clots in January 2006.

You should discuss the abnormal DLCO results with a pulmonologist, with access to the pulmonary function tests (PFTs) raw data.  And, if you are currently not using a long-acting bronchodilator, you should discuss that as well.

Good luck.