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Assessing Obstructive and

Restrictive Patterns

Sudjoko KUSWADJI
Overview
It is often possible to recognize
patterns associated with obstructive or
restrictive lung disease based on the
results of pulmonary function testing.
With obstruction:
Patients may have a normal or modestly reduced
vital capacity, but the volume time tracing of the
forced vital capacity will be abnormal.
There is flattening of the slope of the curve at any
given lung volume, reflecting reduced rate of airflow.
The duration of the forced expiratory maneuver is
prolonged; the changes in the rate of expiratory
airflow reduce the FEV1, FEV3, FEV1-to-FVC, FEV3-
to-FVC, and FEF(25-75%).
In small airway disease: FVC is >= 81% of predicted,
but FEF(25-75%) < 65%.

Pasien mungkin memiliki kapasitas vital normal atau sederhana
berkurang, namun volume waktu penelusuran kapasitas vital
paksa akan abnormal.
Ada merata dari kemiringan kurva pada setiap volume paru-
paru yang diberikan, mencerminkan penurunan laju aliran
udara.
Durasi manuver ekspirasi paksa berkepanjangan, perubahan
dalam tingkat aliran udara ekspirasi mengurangi FEV1, FEV3,
FEV1-to-FVC, FEV3-to-FVC, dan FEF (25-75%).
Pada penyakit saluran napas kecil: FVC adalah> = 81% dari
yang diperkirakan, namun FEF (25-75%) <65%.

FEV1 Interpretation
> 80% predicted normal
66-80% predicted mild obstruction
50-65% predicted moderate obstruction
< 50% predicted severe obstruction


FEV1 to FVC ratio Interpretation
>= 70% of predicted normal
61 - 69% of predicted mild obstruction
45 - 60% of predicted moderate obstruction
< 45% of predicted severe obstruction

FEF(25-75%) Interpretation
>= 66% of predicted normal
50 - 65% of predicted mild obstruction
35 - 49% of predicted moderate obstruction
< 35% of predicted severe obstruction

With restriction:
The configuration of the volume-time tracing may
not be abnormal.
The FEV1 and FEV(3) are low because of the reduced
vital capacity.
The FEV1-to-FVC and FEV(3)-to-FVC are normal or
even increased.
The FEF(25-75%) is lower than predicted.

By examining the ratio of measured-to-predicted
lung capacities it is possible to assess the severity
of restrictive lung disease.
Konfigurasi volume-time tracing mungkin tidak
normal.
The FEV1 dan FEV (3) rendah karena kapasitas vital
berkurang.
FEV1-to-FVC dan FEV (3)-to-FVC normal atau bahkan
meningkat.
The FEF (25-75%) lebih rendah dari yang
diperkirakan.

Dengan memeriksa rasio kapasitas paru diukur-ke-
prediksi adalah mungkin untuk menilai keparahan
penyakit paru restriktif.
VC (vital capacity) Interpretation
>= 81% of predicted normal
66 - 80% of predicted mild restriction
51 - 65% of predicted moderate restriction
<= 50% of predicted severe restriction


TLC (total lung
capacity)
Interpretation
>= 81% of predicted normal
66 - 80% of predicted mild restriction
51 - 65% of predicted moderate restriction
<= 50% of predicted severe restriction

where:
The forced vital capacity (FVC) is reported by some to be equivalent to
vital capacity (VC).
di mana:
kapasitas vital paksa (FVC) dilaporkan oleh beberapa orang untuk
menjadi setara dengan kapasitas vital (VC).
References:
Fishman A (editor). Pulmonary
Diseases and Disorders, Second
Edition. McGraw-Hill Book Company.
1988. pages 2483 and 2510
Murray J, Nadel J. Textbook of
Respiratory Medicine, 2nd edition. W.B.
Saunders Company. 1994. page 871