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Lung function testing in a historical perspective


Hutchinson's subdivsion of lung volumesFig. 1 - Subdivision of the total lung capacity according to Hutchinson (1846).

It took a long time before the introduction of the use of the spirometer by Hutchinson in 1846 [1] led to clinical applications. Inasmuch as it was clinically applied, measurements were limited to the assessment of “vital” capacity (VC), i.e. the slow expiratory vital capacity (EVC) according to today’s terminology. Figure 1 illustrates the subdivision of the total lung capacity in EVC and residual volume in Hutchinson’s publication. It took one century before the French investigators Tiffeneau and Pinelli [2] transformed spirometric measurements to the present form, in which the forced expiratory volume in 1 second (FEV1) and the inspiratory or forced expiratory VC (IVC and FVC) became pivotal diagnostic indices in clinical medicine. Yernault summarised the history of spirometric measurements concisely in a clear and accessible publication [3].

Spirometric test results are significantly influenced by subject cooperation, and are affected by technical factors; it follows that measurements need to be administered according to a strict protocol. In 1960 the European Community for Coal and Steel (ECCS) was the first organisation to issue recommendations [4]. This was followed by an update in 1971 [5], which comprised predicted values for spirometric indices, residual volume, total lung capacity and functional residual capacity. A few years later the first efforts at standardisation were made in the United States, initially only for spirometry in an epidemiological setting [6-7]. Due to rapid technological developments, increased insight in the pathophysiology of lung diseases, and a greater arsenal of clinical lung function tests, a revision of the ECSC report was soon called for [8]. From then on revised standardisation reports were issued in the United States and Europe [9]; American reports dealt with spirometry only, European recommendations covered a wider range of lung function tests and were invariably combined with recommended sets of reference values [10-12).

References

  1. Hutchinson J. On the capacity of the lungs, and on the respiratory functions, with a view of establishing a precise and easy method of detecting disease by the spirometer. Med Chir Trans (London) 1846; 29: 137–252. Link
  2. Tiffeneau R, Pinelli A. Air circulant et air captif dans l’exploration de la fonction ventilatrice pulmonaire. Paris Méd 1947; 37: 624–628.
  3. Yernault JC. The birth and development of the forced expiratory manoeuvre: a tribute to Robert Tiffeneau (1910–1961). Eur Respir J 1997; 10: 2704–2710. Link
  4. Jouasset D. Normalisation des épreuves fonctionnelles respiratoires dans les pays de la Communauté Européenne du Charbon et de l’Acier. Poumon Coeur 1960; 16: 1145–1159.
  5. Cara M, Hentz P (1971). Aide-mémoire of spirographic practice for examining ventilatory function, 2nd edn. (Industrial Health and Medicine series, vol 11) pp. 1-130.
  6. Ferris BC: Epidemiology Standardization Project. Am Rev Respir Dis 1978; 118 (Suppl, part 2): 1-120.
  7. American Thoracic Society. 1979. Standardization of spirometry. Am Rev Respir Dis 1979; 119: 831–838.
  8. Quanjer PH, ed. Standardized lung function testing. Report Working Party Standardization of Lung Function Tests. European Community for Coal and Steel. Bull Eur Physiopathol Respir 1983; 19: Supl. 5, 1–95.
  9. American Thoracic Society. Standardization of spirometry: 1987 update. Am Rev Respir Dis 1987; 136: 1285–1298.
  10. Quanjer PH, Helms P, Bjure J, Gaultier Cl, et al. Standardization of lung function tests in paediatrics. Eur Respir J 1989; 2, Suppl., 4:121s-264s.
  11. Stocks J, Quanjer PH. Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of the European Respiratory Society. Eur Respir J 1995; 8: 492-506.
  12. Quanjer PhH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Standardized Lung Function Testing. Eur Respir J 1993; 6 suppl. 16: 5-100. Erratum Eur Respir J 1995; 8: 1629.

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