RESUMEN

Las pruebas de función respiratoria tienen aplicación clínica rutinaria en la práctica de la neumología. Son de utilidad en el diagnóstico de enfermedades respiratorias, permiten evaluar la respuesta a tratamientos, así como vigilar la progresión funcional y tienen, además, utilidad en la valoración del riesgo perioperatorio y en el pronóstico de diversas enfermedades. En este manuscrito revisamos, desde un punto de vista práctico, las pruebas de función respiratoria que consideramos son las más disponibles y las más útiles desde el punto de vista clínico. El propósito es auxiliar al clínico acerca de la prueba que debe solicitar de acuerdo con las características del paciente haciendo hincapié en que es conveniente evaluar, tanto la mecánica de la respiración como el intercambio gaseoso.

PALABRAS CLAVE

Pruebas de función respiratoria, espirometría, pletismografía corporal, difusión de monóxido de carbono, caminata de seis minutos, prueba cardiopulmonar de ejercicio.

REFERENCIAS

1. Ruppel G. Manual of pulmonary function testing. 7th ed. St Louis, Missouri: Mosby; 1998.

2. Pellegrino R, Viegi G, Brusasco V, et ál. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948-968.

3. Roca R, Rabinovich R. Clinical exercise testing. Eur Respir Mon 2005;31:146-165.

4. Hyatt RE, Scanlon PD, Nakamura M. Interpretation of pulmonary function tests. A practical guide. 3rd ed. Rochester, MN.: Lippincott Williams & Wilkins; 2009.

5. Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-946.

6. Crapo RO, Casaburi R, Coates AL, et ál. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 2000;161:309-329.

7. Miller MR, Hankinson J, Brusasco V, et ál. Standardization of spirometry. Eur Respir J 2005;26:319-338.

8. Vollmer WM, Gislason T, Burney P, et ál. Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study. Eur Respir J 2009;34:588-597.

9. Wanger J, Clausen JL, Coates A, et ál. Standardization of the measurement of lung volumes. Eur Respir J 2005;26:511-522.

10. Casanova C, Cote C, de Torres JP, et ál. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;171:591-597.

11. Macintyre N, Crapo RO, Viegi G, et ál. Standardization of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 2005;26:720-735.

12. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-117.

13. Enright PL, McBurnie MA, Bittner V, et ál. The 6-min walk test: a quick measure of functional status in elderly adults. Chest 2003;123:387-398.

14. Celli BR, Cote CG, Marin JM, et ál. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005-1012.

15. Callens E, Graba S, Gillet-Juvin K, et ál. Measurement of dynamic hyperinflation after a 6-minute walk test in patients with COPD. Chest 2009;136:1466-1472.

16. Miyamoto S, Nagaya N, Satoh T, et ál. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 2000;161(2 Pt 1):487-492.

17. Singh S. Walking for the assessment of patients with chronic obstructive pulmonary disease. Eur Respir Mon 2007;40:148-164.

18. Martinez FJ, Han MK, Andrei AC, et ál. Longitudinal change in the BODE index predicts mortality in severe emphysema. Am J Respir Crit Care Med 2008;178:491-499.

19. Troosters T, Vilaro J, Rabinovich R, et ál. Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease. Eur Respir J 2002;20:564-569.

20. Cardoso F, Tufanin AT, Colucci M, Nascimento O, Jardim JR. Replacement of the 6-min walk test with maximal oxygen consumption in the BODE Index applied to patients with COPD: an equivalency study. Chest 2007;132:477-482.

21. Cahalin LP, Mathier MA, Semigran MJ, Dec GW, DiSalvo TG. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 1996;110:325-332.

22. Swigris JJ, Wamboldt FS, Behr J, et ál. The 6 minute walk in idiopathic pulmonary fibrosis: longitudinal changes and minimum important difference. Thorax 2010;65:173-177.

23. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998;158:1384-1387.

24. Luna PE, Domínguez FME, Rodríguez PA, Gómez HJ. Estandarización de la prueba de caminata de 6 minutos en sujetos mexicanos. Rev Inst Nal Enf Resp Mex 2000;13:205-210.

25. Wise RA, Brown CD. Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test. COPD 2005;2:125-129.

26. Lacasse M, Maltais F, Poirier P, et ál. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med 2005;99:877-886.

27. Vargas-Domínguez C, Mejía-Alfaro R, Martínez-Andrade R, Silva-Cerón M, Vázquez-García JC, Torre-Bouscoulet L. Prueba de desaturación y titulación de oxígeno suplementario. Recomendaciones y procedimiento. Neumol Cir Torax 2009;68:162-173.

28. King TE Jr. Clinical advances in the diagnosis and therapy of the interstitial lung diseases. Am J Respir Crit Care Med 2005;172:268-279.

29. Whipp BJ, Wagner PD, Agusti A. Determinants of the physiological systems responses to muscular exercise in healthy subjects. Eur Respir Mon 2007;40:1-35.

30. Ross RM. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:1451.

31. ERS Task Force, Palange P, Ward SA, et ál. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29:185-209.

32. Wanger J, Crapo R, Irvin ChG. Pulmonary function laboratory management and procedure manual. Arterial blood gas analysis. American Thoracic Society; 2000.

33. Pérez Padilla JR, Vázquez García JC. Estimation of gasometric values at different altitudes above sea level in Mexico. Rev Invest Clin 2000;52:148-155.

34. Pérez-Padilla R, Torre-Bouscoulet L, Muino A, et ál; Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO) group. Prevalence of oxygen desaturation and use of oxygen at home in adults at sea level and at moderate altitude. Eur Respir J 2006;27:594-599.

35. Torre-Bouscoulet L, Chávez-Plascencia E, Vázquez-García JC, Pérez-Padilla R. Precision and accuracy of “a pocket” pulse oximeter in Mexico City. Rev Invest Clin 2006;58:28-33.

36. Beydon N, Davis SD, Lombardi E, et ál. An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007;175:1304-1345.

37. Pérez-Padilla R, Regalado-Pineda J, Rojas M, et ál. Spirometric function in children of Mexico City compared to Mexican-American children. Pediatr Pulmonol 2003;35:177-183.

38. Davis SD. Neonatal and pediatric respiratory diagnostics. Respir Care 2003;48:367-384.

39. Meraz E, Nazeran H, Goldman M, Nava P, Diong B. Impulse oscillometric features of lung function: towards computer-aided classification of respiratory diseases in children. Conf Proc IEEE Eng Med Biol Soc 2008;2008:2443-2446.

40. Lombardi E, Sly PD, Concutelli G, et ál. Reference values of interrupter respiratory resistance in healthy preschool white children. Thorax 2001;56:691-695.

41. Troosters T, Gosselink R, Decramer M. Respiratory muscle assessment. Eur Respir Mon 2005;31:57-71.

42. Calverley P. Control breathing. Eur Respir Mon 2005;31:44-56.

43. Schumacher MJ. Nasal dyspnea: the place of rhinomanometry in its objective assessment. Am J Rhinol 2004;18:41-46.

44. Wagner PD. The multiple inert gas elimination technique (MIGET). Intensive Care Med 2008;34:994-1001.

45. Kushida CA, Littner MR, Morgenthaler T, et ál. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005;28:499-521.

46. Silkoff PE, Erzurum SC, Lundberg JO, et ál. ATS workshop proceedings: exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate. Proc Am Thorac Soc 2006;3:131-145.

47. Pérez-Padilla R, Vázquez-García JC, Márquez MN, et ál. The long-term stability of portable spirometers used in a multinational study of the prevalence of chronic obstructive pulmonary disease. Respir Care 2006;51:1167-1171.