PFTs and progression of emphysema

[twinmomFL]

Hello
For emphysema, which of the basic spirometry tests indicate progression/stability other than FEV1 % predicted?  I know that they all work together to tell the complete picture, but is there any one "red flag"?

This is in regards to my 12yo son, and I'm concerned for his future.  (His emphysema is congenital and has been diagnosed by many professionals/tests).

Here are the most recent PFTs
FVC ..... 99% pred.
FEV1 ..... 54% pred
FEV1/FVC ..... 47%
FEV.5  ..... 46% pred
FEF50% .....20% pred
FEF75% ..... 13% pred
PEF ..... 78%
FEF 25-75% ..... 16%

This was with good reproducibility and good effort.

I would like to look back at some of his older PFTs to compare, but I am not sure which numbers are most important for emphysema.

Thank you in advance.

[National Jewish Health]

Given that your son is just 12 years old, one would in the usual circumstance expect his FEV1 to increase until he attains his full height.  Thus looking simply at the absolute value of his FEV1, one might falsely conclude that his lung condition is improving.  The predicted value takes the change (increase) with age/height into account and so would, as you suggest be the best measure of stability.  In that case, the measured FEV1 (actual)/FEV1 (predicted) would probably be the best measure of stability.  And, in that case should the absolute measured FEV1 either remain the same or decline, that would be evidence of a worsening of his congenital emphysema.

There are reports of surgical management of congenital emphysema (Swyer-James McCleod syndrome).  I have no personal experience with this but you may want to discuss this with one of the “professionals” who have cared for your son, preferably a Pediatric Pulmonologist.  The possibilities would include surgical resection of the emphysematous lung or lobe or, at a later date, consideration of lung transplantation.

His measured pulmonary function is definitely abnormal but within a range, I would imagine, that would allow him to engage in regular exercise and, unless his physicians declare there to be a contraindication to such exercise, he should exercise regularly to maximize his functional capacities, given the limitations posed by the emphysema.

Good luck