Opinion ID: 1131510
Heading Depth: 1
Heading Rank: 2

Heading: Inconsistent test results.

Text: The second edition to the Guides states: The spirometric tests should be performed as described in the 1978 ATS Epidemiology Standardization Project. The equipment, methods of calibration, and techniques should meet the ATS criteria. Guides at 88. The Guides refer to an article: Crapo RO, Morris AH: Reference Spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981; 123:659-664. Guides at 101. This article cites the standards published by the American Thoracic Society at: Gardner RM, et al. Snowbird workshop on standardization of spirometry: a statement by the American Thoracic Society published in the American Review of Respiratory Disease, 1979, 119:831-838. In these referenced materials the American Thoracic Society standards describe acceptable spirometry results as follows: A minimum of 3 acceptable FVC maneuvers will be performed. Acceptability will be determined by the technician's observation that the subject understood the instructions and performed the test with a smooth continous exhalation, with apparent maximal effort, with a good start, and without (1) coughing, (2) Valsalva maneuver (glottis closure). (3) Early termination of expiration ... (4) A leak. (5) An obstructed mouthpiece ... (6) An unsatisfactory start of expiration, characterized by excessive hesitation or false starts ... (7) An excessive variability among the three acceptable curves. The best of the acceptable curves should not vary by more than ± 5 per cent of reading or ± 100ml, whichever is greater. Am Rev Respir Dis 1979; 119 at 836. (Emphasis added). The seventh factor set forth above indicates that spirometry maneuvers which are otherwise acceptable will not be acceptable for rating impairment if the best maneuver varies more than the stated amount. York's two best efforts for FVC were 3.37 liters and 2.19 liters. These two efforts vary by more than 5%, and Dr. F. treated the spirometry results as unacceptable for measuring impairment because of this variation. [7] Thus, Dr. F.'s report did not deviate from the second edition of the Guides merely because he disregarded inconsistent spirometry results.