Is there a discrepancy between a physical law and the spirometric definition of airflow obstruction?


Journal of medical physics and applied sciences is an international peer reviwed journal aiming to publish the most relevant and recent research works across the world. Medical Physicists will contribute to maintaining and improving the quality, safety and cost-effectiveness of healthcare services through patient-oriented activities requiring expert action, involvement or advice regarding the specification, selection, acceptance testing, commissioning, quality assurance/control and optimised clinical use of medical devices and regarding patient risks and protection from associated physical agents (e.g. x-rays, electromagnetic fields, laser light, radionuclides) including the prevention of unintended or accidental exposures; all activities will be based on current best evidence or own scientific research when the available evidence is not sufficient. Medical physics is also called biomedical physics, medical biophysics or applied physics in medicine is, generally speaking, the application of physics concepts, theories and methods to medicine or healthcare.

We are sharing one of the most cited article from our journal. Article entitled “Is there a discrepancy between a physical law and the spirometric definition of airflow obstruction?” was well written by Dr. HosseiniB M.


Background: It has long been emphasized that if physicians rely on clinical signs and symptoms only, they may under-diagnose many of the airflow-limited patients. But what if they rely on spirometry alone and overlook physical examinations as the case is now? Interesting studies on physics of sounds show that wheezing is definitely indicative of an airflow limitation, but, according to current guidelines, presence or absence of wheezes has not been taken into consideration for diagnosis. The purpose of present study was to detect the degree of spirometric deterioration in patients who were physically presumed to have definite airflow obstruction, namely diffuse bilateral wheezes.

Methods: In a cross-sectional study, adult patients complaining of chronic cough and/or dyspnea were visited by two specialists at a pulmonary clinic. If both pulmonologists’ agreement about presence of wheezes, the patients would be sent for spirometry. Spirometry maneuvers were performed according to the American Thoracic Society (ATS) standards. First eighty patients who could perform acceptable spirometry were selected. Prevalence of a forced expiratory volume in first second over forced vital capacity (FEV1 /FVC) and/or FEV1 /slow vital capacity (SVC) below 70% were calculated in these patients with a very highn probability of airflow obstruction based on the physical laws.

Results: In our patients’ setting with diffuse bilateral wheezes, the means of predicted percentages for FEV1, FVC and SVC were 60.3 ± 7.1%, 72.5 ± 17% and 69.9 ± 6.2% respectively. The mean of FEV1 /FVC and FEV1 /SVC could be sequenced as 68.38 ± 10.6% and 68.44 ± 11.6% percent. In 32 (40%) patients, both values were less than 70%, and 31 (38.8%) had both values of more than 70%. On the other hand, in 11 (13.7%) patients, only FEV1/FVC and, in 6 (7.5%), only FEV1/ SVC were less than 70%. As the results show, even in our patients’ setting, those who met the gold standards for airflow obstruction from the viewpoint of physical laws, spirometric obstruction was present only in 61.2% (40%+ 13.7% + 7.5%) of the cases.

Conclusion: The results show a discrepancy between wheezing, as a physical symptom of obstruction, and spirometric findings. Spirometry, as a tool for screening asymptomatic persons, has proved to have a good sensitivity, but the results of present study.

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