Standardised lung function testing.

In 1983 a supplement entitled "Standardised Lung Function Testing" was published by one of our parent journals, the Bulletin Europeen de Physiopathologie Respiratoire [1]. This seminal and widely quoted work reported the recommendations of a Working Party established originally under the auspices of the European Community for Coal and Steel and reflecting the long-standing interest of that body in the respiratory health of industrial workers . The Working Party Report discussed the physiological basis for most of the commonly used tests of lung function and proposed standard methods for their performance. In addition the Working Party reviewed all the available series of normal or reference values and developed a series of "summary equations" based on the pooled data from several reports. These equations were derived by calculation from the various published regression equations of a series of average values for different combinations of height and age. The authors hoped that these equations would be widely applied and might provide standard reference values for use in all laboratories in Europe. Despite some reservations over the statistical validity of this exercise [2], the aims of the Working Party have generally been achieved and the equations proposed are widely used. The current supplement of the journal [3] contains updated versions of two of the most important sections of the original Working Party Report dealing with: (i) lung volumes and forced ventilatory flows and (ii) CO transfer factor (diffusing capacity). A third article reviews tests of airway responsiveness and in effect updates a report produced by the SEPCR, also in 1983 [4]. The sections on respiratory mechanics and CO transfer factor include useful discussions of pathophysiology and interpretation as well as important practical points and recommendations. Most of the recommendations can be supported wholeheartedly, e.g. the definition of a 'restrictive' ventilatory defect in terms of a reduction in total lung capacity; the emphasis on measurement of relaxed rather than forced vital capacity; the recommendation, in the plethysmographic technique for measurement of total lung capacity (TLC), for the subject to perform an inspiratory capacity manoeuvre immediately after estimation of thoracic gas volume; clarification of the confusing distinction between forced expiratory flow (FEF) and maximal expiratory flow (MEF) with a recommendation to report the latter, i.e. flow related to the lung