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Park, Lee, Huh, Oh, Lee, Lee, Yoon, Kim, Lee, Park, Kim, Park, Hwang, Jung, Park, Lim, Jung, Kim, Kim, Rhee, Yoon, Kim, Kim, Yoo, and Yoo: Proposal of New Criteria for Assessing Respiratory Impairment
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Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(3): 199-205.

Published online: 31 March 2011

DOI: https://doi.org/10.4046/trd.2011.70.3.199

Proposal of New Criteria for Assessing Respiratory Impairment

Joo Hun Park, M.D.1, *, Jae Seung Lee, M.D.2, *, Jin-Won Huh, M.D.2, Yeon-Mok Oh, M.D.2, Sang-Do Lee, M.D.2, Sei Won Lee, M.D.3, Ho Il Yoon, M.D.3, Deog Kyeom Kim, M.D.4, Chang Hoon Lee, M.D.4, Myung Jae Park, M.D.5, Eun Kyung Kim, M.D.6, Yong Bum Park, M.D.7, Yong Il Hwang, M.D.8, Ki-Suck Jung, M.D.8, Hye Yoon Park, M.D.9, Seong Yong Lim, M.D.10, Ji-Ye Jung, M.D.11, Young Sam Kim, M.D.11, Hui Jung Kim, M.D.12, Chin Kook Rhee, M.D.13, Hyoung-Kyu Yoon, M.D.15, Young Kyoon Kim, M.D.13, Jin Woo Kim, M.D.14, Jee-Hong Yoo, M.D.5, Kwang Ha Yoo, 16

1Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.

2Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

4Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

5Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.

6Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

7Department of Internal Medicine, Hallym University Sacred Heart Hospital, Seoul, Korea.

8Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.

9Department of Internal Medicine, Samsung Medical Center, Seoul, Korea.

10Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

11Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

12Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea.

13Department of Internal Medicine, St. Mary's Hospital, Seoul, Korea.

14Department of Internal Medicine, Uijeongbu St. Marry's Hospital, Uijeongbu, Korea.

15Department of Internal Medicine, Yeouido St. Marry's Hosital, The Catholic University of Korea College of Medicine, Seoul, Korea.

16Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea.

Address for correspondence: Kwang Ha Yoo, M.D. Department of Internal Medicine, Konkuk University Hospital, Konkuk University College of Medicine, Hwayang- ong, Gwanjin-gu, Seoul 143-729, Korea. Phone: 82-2-2030-7522, Fax: 82-2-2030-7458, khyou@kuh.ac.kr

Equal contributor:

*These two authors equally contributed to this work.

Received 9 February 2011       Accepted 14 March 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Social welfare services for respiratory-disabled persons in Korea are offered based on the respiratory impairment grade, which is determined by 3 clinical parameters; dyspnea, forced expiratory volume in 1 second (FEV1), and arterial oxygen tension. This grading system has several limitations in the objective assessment of respiratory impairment. We reviewed several guidelines for the evaluation of respiratory impairment and relevant articles. Then, we discussed a new grading system with respiratory physicians. Both researchers and respiratory physicians agreed that pulmonary function tests are essential in assessing the severity of respiratory impairment, forced vital capacity (FVC), FEV1 and single breath diffusing capacity (DLco) are the primarily recommended tests. In addition, we agreed that arterial blood gas analysis should be reserved for selected patients. In conclusion, we propose a new respiratory impairment grading system utilizing a combination FVC, FEV1 and DLco scores, with more social discussion included.

Keywords: Respiratory System, Disability Evaluation, Respiratory Function Tests, Spirometry, Pulmonary Diffusing Capacity

Figures and Tables

Table 1
Respiratory impairment grading according to Welfare of Disabled Persons Act4
trd-70-199-i001

FEV1: forced vital capacity in 1 second; PaO2: arterial oxygen tension.

Table 2
Respiratory impairment grading according to guidelines of the Korean Academy of Medical Science6
trd-70-199-i002

FVC: forced vital capacity; FEV1: forced vital capacity in 1 second; DLco: diffusing capacity for carbon monoxide; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension.

Table 3
American Thoracic Society impairment categories, with corresponding description of ability to perform job demands8
trd-70-199-i003

FVC: forced vital capacity; FEV1: forced vital capacity in 1 second; DLco: diffusing capacity for carbon monoxide.

Table 4
American Medical Association classification of respiratory impairment9
trd-70-199-i004

FVC: forced vital capacity; FEV1: forced vital capacity in 1 second; DLco: diffusing capacity for carbon monoxide; VO2max: maximum oxygen consumption; LLN: lower limit of normal.

Table 5
Proposal of new criteria for assessing respiratory impairment
trd-70-199-i005

FVC: forced vital capacity; FEV1: forced vital capacity in 1 second; DLco: diffusing capacity for carbon monoxide.

Notes

All institutions which participated in this study are designated clinical research center for chronic obstructive airway diseases by Ministry of Health and Welfare.

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