of the air will go into the spirometer to be measured. The patient will also wear nose clips to keep air from leaking out of your nose.

2. After breathing normally patient will be asked to blow out until his lungs are empty slowly.
3. Then they will take a big, deep breath to fill up their lungs completely.
4. As soon as their lungs are full, they will blow out as hard and as fast as you can until their lungs are empty.
5. They will be asked to repeat the test until there are three reasonable efforts.
6. If an obstructive defect is present, the patient is given 200 mcg Levosalbutamol via MDI and the test is repeated after 15 minutes to assess the reversibility.

This test allows us to measure:

• Forced Vital Capacity (FVC) - the amount of air one can force out of his lungs after a maximum inspiration
• Forced Expiratory Volume in the first second (FEV1)
• Peak Expiratory Flow Rate (PEFR) - how fast one can blow out the air in your lungs
• Forced Inspiratory Vital Capacity (FIVC) - the amount of air one can take into your lungs
• The shape of your Flow Volume Loop (FVC + FIVC) also provides information to us.

Getting Started

Before PFT results can be reliably interpreted, three factors must be confirmed:

(1) The volume-time curve reaches a plateau, and expiration lasts at least six seconds;

(2) Results of the two best efforts on the PFT are within 0.2 L of each other; and

(3) The flow-volume loops are free of artefacts and abnormalities [.5] If the patient's efforts yield flattened flow-volume loops, the submaximal effort is most likely; however, central or upper airway obstruction should be considered.

Step 1: To determine if the FEV1/FVC ratio is low, thereby confirming the obstructive pattern.

Step 2: To determine if the FVC is Low

4. Printer
5. Disposable mouthpiece
6. Disposable nose piece
7. A 3-L syringe for calibration

A total of 60 patients above 18 years of age having respiratory distress were included in the study.

Pulmonary function tests with bronchodilator reversibility were done among those patients after taking their consents.

The key borderline characteristics are listed in Table 1.

Table-1: Distribution of PFT outcome.

Figure 1 represents Age distribution among the patients having abnormal PFTs shows that maximum numbers of them are in the age group 31-50 years (total 21 patients, 42%) followed by group of 18-30 years (Total 12 patients, 24%).

Fig-1: Age group distribution.

Among 50 patients, 36 were males (72%) and the rest 14 was females (28%).

Fig-2: Gender distribution of patients with abnormal PFT.

Fig-8: Age sex distribution of patients having mixed obstructive and restrictive features (n=10).

The present study has been compared with those of the other reviews of the pulmonary function test and its various implications. The present study has a few critical observations. Out of 60 patients of breathlessness that had undergone PFT, 50 of them (83.33%) showed abnormalities in lung function.

The comparison of outcomes between symptomatic individuals with and without the chronic obstructive pulmonary disease (COPD) has been one of the many research questions posed in an American Thoracic Society/European Respiratory Society statement [6]. It represents the main thrust of this Pulmonary Perspective.

Gender difference has a significant impact in society among the patients of breathlessness. In a study conducted by Shiva D. Rahmanian et al, it was found that the majority of the participants were male (87.6%). There was a significantly higher percentage of cough and phlegm production in males.

There was also a lower FEV1 and a higher RV in males than females [7]. It is in accordance with the present study where it was founded that 72% of patients with abnormal PFTs are male, rest 28% are females.

A large study conducted by Dr Earl S. Ford et al to look for trends in the prevalence of obstructive and restrictive lung function among adults in the United States, it was found that during 2007-2010, 13.5% (SE, 0.6) of participants had evidence of airway obstruction (FEV1/FVC, <0.70): 79.9% of adults had normal lung function, 6.5% had a restrictive impairment, 7.5% had mild obstruction, 5.4% had moderate obstruction, and 0.7% had severe obstruction [8].

In another large study conducted by J. Vandevoorde et al which was subsequently published in European

In restrictive lung disease, both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are reduced, however, the decline in FVC is more than that of FEV1, resulting in a higher than 80% FEV1/FVC ratio. This indicates that the FVC is also reduced, but not by the same ratio as FEV1. Barreiro TJ et al, in their study precisely provided a stepwise approach for the interpretation of spirometry [15].

In their research they pointed out that Spirometry is a powerful tool that can be used to detect, follow, and manage patients with lung disorders. Technology advancements have made spirometry much more reliable and relatively simple to incorporate into a routine office visit.

However, interpreting spirometry results can be challenging because the quality of the test is largely dependent on patient effort and cooperation, and the interpreter's knowledge of appropriate reference values.

A simplified and stepwise method is key to interpreting spirometry. The first step is determining the validity of the test. Next, the determination of obstructive or restrictive ventilatory pattern is made. If a ventilatory pattern is identified, its severity is graded. In some patients, additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing are needed.

These tests can further define lung processes but require more sophisticated equipment and expertise available only in a pulmonary function laboratory. Aaron SD et al demonstrated in their study the accuracy of diagnosing restrictive lung diseases by pulmonary function test [16].

They concluded that Spirometry is very useful at excluding a restrictive defect. When the VC is within the normal range, the probability of a restrictive defect is < 3%, and unless restrictive lung disease is suspected a priori, measurement of lung volumes can be avoided.

However, spirometry is not able to accurately predict lung restriction; < 60% of patients with a classical spirometric restrictive pattern had pulmonary restriction confirmed on lung volume measurements. For these patients, measurement of the TLC is needed to confirm a true restrictive defect.

The current study found 8 patients of restrictive lung diseases (16%) having low FVC with high or

Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT]), spirometry and self-reported exacerbation history [19]. TA study of the distribution of COPD in UK general practice using the new GOLD classification by John Haughney et al, data for 9219 COPD patients were collected.

For the 6283 patients with both forced expiratory volume in 1 s (FEV1) and modified Medical Research Council scores (mean±sd age 69.2±10.6 years, body mass index 27.3±6.2 kg·m−2), GOLD 2011 group distributions were: A (low risk and fewer symptoms) 36.1%, B (low risk and more symptoms) 19.1%, C (high risk and fewer symptoms) 19.6% and D (high risk and more symptoms) 25.3%.

This is in contrast with GOLD 2007 stage classification: I (mild) 17.1%, II (moderate) 52.2%, III (severe) 25.5% and IV (very severe) 5.2%. 20% of patients with FEV1 ≥50% predicted had more than two exacerbations in the previous 12 months. 70% of patients with FEV1 <50% pred had fewer than two exacerbations in the previous 12 months [20].

1. Small numbers of patients were included in the study.
2. DLCO could not be performed among patients with high FEV1/FVC to confirm restrictive lung diseases.

• Prevalence of respiratory distressed patients are more among males than females.
• Prevalence is also more in the middle age group.
• Obstructive variety is much more prevalent than others.
• Among obstructive airway diseases, reversible features are much more prevalent, more so in younger age group.

There is not much difference in the prevalence among restrictive and mixed varieties. non-reversible obstructive airway diseases. Among the non-reversible obstructive airway diseases, severity classes of GOLD 2 and GOLD 3 are more prevalent