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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Health professionals who treat patients with respiratory diseases do not seem to be so keen on conducting lung function tests &#40;LFT&#41; as they used to be&#46; However&#44; LFTs are increasingly important in the diagnosis and treatment of many lung diseases&#46; For example&#44; in the recent development of 2 antifibrotics&#44; pirfenidone and nintedanib&#44; for idiopathic pulmonary fibrosis&#44; effectiveness was assessed in terms of delaying forced vital capacity decline&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In addition to spirometry&#44; other lung function parameters&#44; such as carbon monoxide transfer factor &#40;TLco&#41;&#44; are considered essential for assessing the effectiveness of other new antifibrotics&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In chronic obstructive pulmonary disease&#44; forced spirometry is required for diagnosis and staging&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> However&#44; increasing numbers of authors believe that other LFT parameters&#44; such as TLco or forced oscillation technique &#40;FOT&#41;&#44; are essential for an early diagnosis&#46; These tests correlate well with symptoms and are also useful for assessing the effectiveness of new treatments in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The situation is similar in other highly prevalent diseases&#44; such as bronchial asthma or neuromuscular diseases&#46; Subjects with impaired lung growth have also demonstrated abnormal lung function parameters during their development&#44; leading to a higher prevalence of cardiovascular and metabolic diseases<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a> and increased risk of mortality from cardiac and pulmonary diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Another characteristic of LFTs is that the same result is often interpreted differently&#44; depending on the laboratory in which the test was conducted&#44; with wide discrepancies in what was defined as the normal range of values observed in a healthy population&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The Global Lung Function Initiative &#40;GLI&#41;&#44; along with other international scientific societies&#44; such as the American Thoracic Society &#40;ATS&#41; and the European Respiratory Society &#40;ERS&#41;&#44; have decided to clarify the interpretation of LFTs&#44; especially with regard to use of the lower limit of normal and the <span class="elsevierStyleItalic">Z</span>-score to differentiate between health and disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;8</span></a> The ATS has also recently recommended standardizing LFT parameters in the final report by including absolute and reference values expressed as percentages of the mean&#44; lower limit of normal&#44; and <span class="elsevierStyleItalic">Z</span>-score&#44; along with a quality grading system&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> The GLI also standardized reference equations that can be taken as universal for spirometry parameters &#40;2012&#41;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> and for TLco &#40;2017&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Future GLI initiatives will include reference equations for static lung volumes&#44; exhaled nitric oxide&#44; and FOT&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Tools are now being used to facilitate communication between health systems specific to each healthcare site or hospital with the purpose of accessing patient data&#59; one example is the patient electronic health record &#40;EHR&#41;&#46; For health data to be entered in the EHR&#44; they must be structured and standardized&#46; In this respect&#44; initiatives have emerged to include forced spirometry data in the EHR in Catalonia<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> and the Basque Country&#44; in order to comply with centralized quality control programs&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> Access to structured data also makes it easier to incorporate quality control algorithms that improve the conduct of maneuvers during a spirometry test&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> thus minimizing the proportion of low quality tests in non-specialized centers&#46; Finally&#44; we must highlight the recent initiative led by the ATS to standardize LFT data in a structured format&#59; a consensus document in this regard may be available in early 2020&#44; that will also facilitate the recording of LFTs in the EHR&#46; These strategies and big data analysis methods will help generate valuable new information on the association between LFT parameters and lifelong health that might have relevance in the future&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incorporation of new technologies has also led to progress in the development of simpler and more sensitive lung function testing equipment&#46; Ultrasound spirometry machines that do not require calibration are now available&#46; The use of these ultrasound spirometers in diffusion testing systems has led to more compact devices that can also measure lung diffusion of nitric oxide&#44; differentiating the capillary components from the membrane components&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> New technologies using flow interruption techniques can measure lung volumes in compact portable systems&#44; a factor that will contribute to their generalized application&#46; Techniques such as FOT and multiple-breath inert gas washout tests are also gradually appearing in our laboratories&#46; Notwithstanding&#44; some basic tests for the diagnosis of respiratory diseases&#44; such ascardiopulmonary exertion testing&#44; continue to be regarded as an exclusively cardiological procedure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In recent years&#44; national and international respiratory medicine societies have pledged their support for lung function testing with training programs and resident rotations &#40;e&#46;g&#46;&#44; the Aquiles&#44; Atenea&#44; and Ulises programs&#44; the ERS-SEPAR spirometry driving license&#44; EOS&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14&#44;15</span></a> Formal training will&#44; without a doubt&#44; lead to a qualitative improvement the quality of lung function laboratories &#40;LFL&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the climate of advancement in the field of LFTs&#44; the Spanish Society of Pneumology and Thoracic Surgery&#39;s &#40;SEPAR&#41; failure to include LFLs in their accreditation of units of this type appears groundless&#44; but this situation is currently being resolved&#46; Criteria for LFL accreditation are now classified on 3 levels&#44; corresponding to high complexity&#44; advanced and basic units&#44; offering laboratories an opportunity to obtain a certificate of excellence at each level&#46; In this type of LFL accreditation&#44; not only self-evaluation but also the assessment destined for each of the levels will have a very important role&#46; Formal training and LFL accreditation should drive significant improvements in the quality of the tests and promote greater awareness among the new generations of pulmonologists&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In summary&#44; considerable advances have been made in recent years in both technological features and LFT protocols&#59; however&#44; these do not seem to have filtered down to the health professionals who treat patients with respiratory diseases&#46; National and international scientific respiratory medicine societies have opted to promote the profile of lung function testing&#44; but it looks as if we will have to design strategies to motivate professionals to implement and develop their use of LFTs&#46;</p></span>"
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Editorial
Lung Function is Not Outdated
La función pulmonar no está pasada de moda
Juana Martínez Llorensa,b,h,
Corresponding author
JMartinezL@parcdesdalutmar.cat

Corresponding author.
, Felip Burgosc,d,e,h, Juan B. Galdizf,g,h
a Servicio de Neumología, Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain
b DCEXS, Universitat Pompeu Fabra, Barcelona, Spain
c Centro de Diagnóstico Respiratorio, Hospital Clínic, Barcelona, Spain
d Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
e Universitat de Barcelona, Barcelona, Spain
f Laboratorio de Exploración Funcional, Servicio Neumología, Hospital Universitario Cruces, Bilbao, Spain
g Biocruces, Bilbao, Spain
h Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES)-Madrid CIBERES, ISCiii, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Health professionals who treat patients with respiratory diseases do not seem to be so keen on conducting lung function tests &#40;LFT&#41; as they used to be&#46; However&#44; LFTs are increasingly important in the diagnosis and treatment of many lung diseases&#46; For example&#44; in the recent development of 2 antifibrotics&#44; pirfenidone and nintedanib&#44; for idiopathic pulmonary fibrosis&#44; effectiveness was assessed in terms of delaying forced vital capacity decline&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In addition to spirometry&#44; other lung function parameters&#44; such as carbon monoxide transfer factor &#40;TLco&#41;&#44; are considered essential for assessing the effectiveness of other new antifibrotics&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In chronic obstructive pulmonary disease&#44; forced spirometry is required for diagnosis and staging&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> However&#44; increasing numbers of authors believe that other LFT parameters&#44; such as TLco or forced oscillation technique &#40;FOT&#41;&#44; are essential for an early diagnosis&#46; These tests correlate well with symptoms and are also useful for assessing the effectiveness of new treatments in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The situation is similar in other highly prevalent diseases&#44; such as bronchial asthma or neuromuscular diseases&#46; Subjects with impaired lung growth have also demonstrated abnormal lung function parameters during their development&#44; leading to a higher prevalence of cardiovascular and metabolic diseases<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a> and increased risk of mortality from cardiac and pulmonary diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Another characteristic of LFTs is that the same result is often interpreted differently&#44; depending on the laboratory in which the test was conducted&#44; with wide discrepancies in what was defined as the normal range of values observed in a healthy population&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The Global Lung Function Initiative &#40;GLI&#41;&#44; along with other international scientific societies&#44; such as the American Thoracic Society &#40;ATS&#41; and the European Respiratory Society &#40;ERS&#41;&#44; have decided to clarify the interpretation of LFTs&#44; especially with regard to use of the lower limit of normal and the <span class="elsevierStyleItalic">Z</span>-score to differentiate between health and disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;8</span></a> The ATS has also recently recommended standardizing LFT parameters in the final report by including absolute and reference values expressed as percentages of the mean&#44; lower limit of normal&#44; and <span class="elsevierStyleItalic">Z</span>-score&#44; along with a quality grading system&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> The GLI also standardized reference equations that can be taken as universal for spirometry parameters &#40;2012&#41;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> and for TLco &#40;2017&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Future GLI initiatives will include reference equations for static lung volumes&#44; exhaled nitric oxide&#44; and FOT&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Tools are now being used to facilitate communication between health systems specific to each healthcare site or hospital with the purpose of accessing patient data&#59; one example is the patient electronic health record &#40;EHR&#41;&#46; For health data to be entered in the EHR&#44; they must be structured and standardized&#46; In this respect&#44; initiatives have emerged to include forced spirometry data in the EHR in Catalonia<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> and the Basque Country&#44; in order to comply with centralized quality control programs&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> Access to structured data also makes it easier to incorporate quality control algorithms that improve the conduct of maneuvers during a spirometry test&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> thus minimizing the proportion of low quality tests in non-specialized centers&#46; Finally&#44; we must highlight the recent initiative led by the ATS to standardize LFT data in a structured format&#59; a consensus document in this regard may be available in early 2020&#44; that will also facilitate the recording of LFTs in the EHR&#46; These strategies and big data analysis methods will help generate valuable new information on the association between LFT parameters and lifelong health that might have relevance in the future&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incorporation of new technologies has also led to progress in the development of simpler and more sensitive lung function testing equipment&#46; Ultrasound spirometry machines that do not require calibration are now available&#46; The use of these ultrasound spirometers in diffusion testing systems has led to more compact devices that can also measure lung diffusion of nitric oxide&#44; differentiating the capillary components from the membrane components&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> New technologies using flow interruption techniques can measure lung volumes in compact portable systems&#44; a factor that will contribute to their generalized application&#46; Techniques such as FOT and multiple-breath inert gas washout tests are also gradually appearing in our laboratories&#46; Notwithstanding&#44; some basic tests for the diagnosis of respiratory diseases&#44; such ascardiopulmonary exertion testing&#44; continue to be regarded as an exclusively cardiological procedure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In recent years&#44; national and international respiratory medicine societies have pledged their support for lung function testing with training programs and resident rotations &#40;e&#46;g&#46;&#44; the Aquiles&#44; Atenea&#44; and Ulises programs&#44; the ERS-SEPAR spirometry driving license&#44; EOS&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14&#44;15</span></a> Formal training will&#44; without a doubt&#44; lead to a qualitative improvement the quality of lung function laboratories &#40;LFL&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the climate of advancement in the field of LFTs&#44; the Spanish Society of Pneumology and Thoracic Surgery&#39;s &#40;SEPAR&#41; failure to include LFLs in their accreditation of units of this type appears groundless&#44; but this situation is currently being resolved&#46; Criteria for LFL accreditation are now classified on 3 levels&#44; corresponding to high complexity&#44; advanced and basic units&#44; offering laboratories an opportunity to obtain a certificate of excellence at each level&#46; In this type of LFL accreditation&#44; not only self-evaluation but also the assessment destined for each of the levels will have a very important role&#46; Formal training and LFL accreditation should drive significant improvements in the quality of the tests and promote greater awareness among the new generations of pulmonologists&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In summary&#44; considerable advances have been made in recent years in both technological features and LFT protocols&#59; however&#44; these do not seem to have filtered down to the health professionals who treat patients with respiratory diseases&#46; National and international scientific respiratory medicine societies have opted to promote the profile of lung function testing&#44; but it looks as if we will have to design strategies to motivate professionals to implement and develop their use of LFTs&#46;</p></span>"
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ISSN: 15792129
Original language: English
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