THE SUPERIORITY OF EXERCISE TESTING OVER SPIROMETRY IN THE EVALUATIONOF POSTOPERATIVE LUNG-FUNCTION FOR PATIENTS WITH PULMONARY-DISEASE

Thoracic surgeons have often been embarrassed by the discrepancy betwe en an improvement in symptoms and the unchanged or even worse results of spirometry in postoperative patients with either bullae or inflamma tory lung disease. Forty-four patients with lung diseases, who underwe nt a total of 47 operations, were categorized as follows: 12 cases of empyema, 16 cases of giant bulla (undergoing surgery a total of 19 tim es), 4 cases of bronchiectasis, and 12 cases of other miscellaneous di seases. All patients were tested preoperatively and again 4-6 months a fter surgery on both the spirometer and treadmill exercise tests. The forced vital capacity (FVC) and forced expiratory volume (FEV(1.0)) re sults were as follows: the empyema group 1.82 +/- 0.52 liters preopera tively to 1.93 +/- 0.69 liters postoperatively and 1.47 +/- 0.44 liter s to 1.56 +/- 0.53 liters, respectively; and the giant bulla group, 3. 49 +/- 0.96 liters to 3.35 +/- 0.77 liters and 2.35 +/- 0.96 liters to 2.48 + 0.69 liters, respectively. However, the exercise time was prol onged in the empyema group from 6.00 +/- 3.77 min to 8.33 +/- 3.80 min (P < 0.01) and in the giant bulla group from 11.83 +/- 3.71 min to 12 .92 +/- 2.84 min (P < 0.05). It was thus concluded that exercise testi ng should be chosen for the postoperative evaluation of patients with inflammatory pulmonary disease and giant bullae, especially if any dis crepancies are seen between spirometry and performance status, because on the basis of our results, it appears that the benefits obtained by surgery are best measured by the dynamic values of exercise testing a nd not by the static values of spirometry at rest.