The promotion and application of pulmonary function tests (PFTs) in China have achieved preliminary success;however, numerous deficiencies persist in multidisciplinary PFT clinical application pathways and management. Current challenges remain in identifing target population, implementing pathways within and outside medical institutions, allocating hardware, training personnel, managing information, and assessing performance.The consensus aims to optimize multidisciplinary clinical pathways and management models for PFTs by leveraging information technology and strengthening organizational coordination. Using a modified Delphi method and a systematic literature review, 14 core clinical questions were identified across four categories: (1) cognitive and information management platforms, (2) laboratory infrastructure and personnel, (3) performance evaluation, and (4) outreach and expansion capabilities. Furthermore, it proposes targeted and feasible implementation pathways and solutions, aiming to standardize PFTs practices and enhance multidisciplinary collaboration nationwide.Summary of Key RecommendationsQuestion 1: How to identify the candidates eligible for PFTs?Recommendation 1: By defining keywords for the PFT-eligible population, clinical physicians can enhance their ability to identify individuals at high risk for pulmonary function abnormalities and increase PFT utilization rates. The eligible candidates can be automatically identified through Hospital Information System (HIS) that recognize keywords in outpatient or inpatient records and trigger pop-up alerts.Question 2: If pop-up alerts are not feasible, which scales can be used to assist in identifying the PFT-eligible candidates?Recommendation 2: Evaluating patients' history of high-risk exposure or completing the screening questionnaires before visits can help improve the identification rate of the PFT-eligible candidates. Questionnaires include the Chronic Obstructive Pulmonary Disease Screening Questionnaire (COPD-SQ) or the Lung Function Screening Questionnaire (LFQ), etc. (Strong Recommendation)Currently, the COPD-SQ and LFQ questionnaires are commonly used for screening high-risk COPD populations. Due to the low cost and ease of use, they are suitable for widespread use across all levels of medical institutions. Other risk factors such as significant exposure to biomass fuels, asthma, and recurrent respiratory infections in early childhood can also lead to lung function decline or impaired lung development. Some necessary items can be added to improve the sensitivity and applicability of PFTs, forming a modified version or Chinese version of PFT screening tool.Question 3: How to select appropriate PFT modalities based on clinical needs?Recommendation 3: Physicians should select the optimal testing methods and their combinations based on each patient's specific clinical status. (Strong Recommendation)PFTs include basic and advanced tests. Basic tests primarily refer to pulmonary ventilation function tests (spirometry) or forced oscillation technique (FOT). The latter is particularly suitable for patients with ventilation impairments who cannot cooperate with forced expiratory maneuvers. Advanced tests include Bronchodilator Test/Bronchodilator Reversibility Test, Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) test, Lung Plethysmography, Airway Resistance Assessment, Fractional Exhaled Nitric Oxide (FeNO) test, 6-Minute Walk Test (6MWT), Cardiopulmonary Exercise Testing, etc. Physicians should strategically combine these tests into different clinical pathways according to the results of PFTs and clinical needs.Question 4: How to delineate responsibilities and implementation protocols for PFTs among different hospital departments?Recommendation 4: The attending physician who orders the PFT should follow up on the results and proceed with subsequent tests independently or by consulting with clinical specialists. If discrepancies are found, PFT laboratory staff should communicate in a timely and two-way manner to form a closed loop with the attending physician, including timely adjustment of test items, handling of emergencies, and explaining results to the patients. When necessary, PFT specialists should participate in clinical consultations. (Strong Recommendation)Question 5: How to develop the PFT pathways for health centers?Recommendation 5: Health centers should incorporate PFTs into routine physical examinations. For individuals aged ≥40 years, or those with high-risk factors for chronic respiratory diseases (such as a long-term smoking history, exposure to dusts, chronic respiratory symptoms, or a family history of chronic respiratory diseases), PFTs should be mandatory. After tests, the PFT results should be included in the health reports to provide information for health or referral recommendations. (Strong Recommendation)Question 6: How to establish PFT pathways based on imaging findings?Recommendation 6: For patients with abnormal radiographic findings such as emphysema, pulmonary fibrosis, or bronchiectasis, further PFTs should be recommended.① Keywords in manual or electronical imaging reports should be used to prompt the PFTs. Keywords for chest X-ray include: emphysema, pulmonary bullae, tracheal stenosis, bronchial wall thickening, mucous plugging, distal bronchiolar destruction, bronchiectasis, reticular and honeycomb-like lesions, interstitial fibrosis, chest wall deformity, etc. Keywords for CT imaging include: airway wall thickening,≥5% emphysema involvement (defined as areas with lung density below -950 HU), destruction or abnormal mucous plugging in distal bronchioles, atelectasis, giant lung mass, moderate or severe pleural effusion, etc. (Strong Recommendation)② Institutions with the requisite facilities are recommended to optimize the diagnosis and treatment of respiratory system diseases by integrating Artificial Intelligence (AI)-enhanced CT with PFTs. Using AI-CT for in-depth analysis of chest CT images can automatically assist in identifying lung lesions and, combined with PFT data, provide more accurate recommendations for clinical management. (Strong Recommendation)Question 7: How to enable the digital transmission of PFT data?Recommendation 7① PFT reports from different PFT analyzers should be integrated with HIS, picture archiving and communication system (PACS)and laboratory information system (LIS)to enable automated data synchronization. (Strong Recommendation)② Recommendations for information system access standards and conversion requirements: digital PFT reports should follow a unified and standardized format for HIS integration, including the patient's demographics, test indicators, data, images and the electronic signature of the operator or reviewing physician. If digital data cannot be integrated, images or PDFs of the reports can be uploaded to PACS. (Strong Recommendation)Question 8: How to establish a standardized PFT data platform within healthcare institutions?Recommendation 8① Integrate PFT data across all hospital departments to ensure real-time, accurate synchronization with the Hospital Information System (HIS). Records of the types, frequency and results of PFTs can be used to establish the unified, standardized PFT database for centralized management and analysis. (Strong Recommendation)② The platform should feature basic functions such as data storage, querying, statistics and quality control. It is recommended to embed a standardized quality assessment and grading system within electronic reports to assist clinicians in rapidly evaluating data quality and interpreting the reliability of results. (Strong Recommendation)③ Patients with confirmed chronic respiratory diseases should be integrated into the platform, or PFT data should be incorporated into existing patient management systems. This integration supports clinical research and hospital administration and enables the visual management of longitudinal pulmonary function data. (Strong Recommendation)Question 9: How to establish a Cloud-based Data Sharing Platform?Recommendation 9: Standards and specifications for uploading PFT data should be established to ensure data security and patient privacy. PFT data sharing among medical institutions within the region should be achieved through regional cloud storage to provide the data support for hierarchical diagnosis and treatment and telemedicine. In principle, patient information should be anonymized prior to being uploaded to regional sub-centers. Regional sub-centers are responsible for reviewing reports, revising conclusions, and assigning quality control ratings. The cloud data center should aggregate the quality control data from all sub-centers, and regularly evaluate and sample the sub-centers' quality control reports. (Strong Recommendation)Question 10: How to improve the quality control and the interpretation of PFTs?Recommendation 10① Quality control and interpretation of PFT results should be performed by physicians or technicians who have received specialized training in PFTs and possess relevant qualifications. In addition, AI can be utilized to achieve quality control and interpretation of pulmonary function test results, promoting the optimal allocation of medical resources and improving efficiency. (Strong Recommendation)② Implementation methods for AI-assisted PFTs: PFT equipment manufacturers should integrate AI-assisted PFT systems into instruments or cloud platforms. Using AI deep learning and other models to automatically identify abnormalities, the acceptability, repeatability and quality grading of PFT results can be intelligently interpreted, more accurately distinguishing types of ventilation dysfunction, improving diagnostic accuracy and efficiency, and achieving efficient automatic identification of abnormal populations. (Strong Recommendation)Currently, quality control and result interpretation of PFTs rely primarily on manual assessment, which is inefficient, subject to observer bias, and requires trained and qualified personnel. The introduction of AI technology can enable automatic quality control and assisted interpretation of PFT data, enhancing the efficiency and quality of PFTs.AI deep learning models based on large-scale standardized PFT data can perform real-time evaluation of data collection and curve quality during the testing process, issuing timely warnings and requesting re-testing for unqualified results. Acceptable PFT results can be used for further determining the abnormalities, assessing the type and severity of pulmonary function impairment, and intelligently generating real-time warnings, patient guidance and auxiliary interpretation, improving the quality control and interpretation efficiency of PFT results.Question 11: How to configure equipment and personnel for the PFT laboratory?Recommendation 11① Space configuration: A comfortable examination environment for patients should be provided by establishing PFT suites, ensuring reasonable spatial layout with proper ventilation and temperature/humidity control. (Strong Recommendation)② Hardware configuration: The PFT devices should be equipped according to the specific needs of the healthcare institution. The equipment should comply with industry technical specifications, undergo regular calibration and maintenance, and be documented in comprehensive equipment management logs. (Strong Recommendation)③ Personnel configuration: The full-time technical personnel should be assigned reasonably according to the equipment and workload needs, and should undergo the relevant training and pass the assessments. (Strong Recommendation)Question 12: How to improve the patient experience and PFT efficiency?Recommendation 12① By setting up self-service terminals for PFTs or using mobile applications, the process of registration, payment, appointment, check-in, and report viewing can be completed quickly, which helps improve the patient experience, reduce waiting time, and optimize workflow. (Strong Recommendation)② Instructional videos can visually help patients learn about the significance of PFTs, improve maneuver compliance, and adherence to precautions. (Strong Recommendation)③ Adopting augmented reality technology (e.g., head-mounted displays) helps facilitate rapid learning and improved testing efficiency. Providing an immersive interactive experience increases patient engagement and understanding, which helps to improve the implementation rate and efficiency of PFTs. (Strong Recommendation)Question 13: When conducting multidisciplinary PFTs, how to set the target testing rates for different departments?Recommendation 13: In addition to routine clinical application in the Department of Pulmonary and Critical Care Medicine (PCCM), PFTs are also significant in multiple departments such as Surgery, Cardiology and Geriatrics, and should be encouraged in high-risk populations. It is recommended that the proportion of PFTs ordered by clinical departments other than PCCM Department and Thoracic Surgery Department should constitute more than 30% of the total hospital-wide PFT volume. (Strong Recommendation)Question 14: How to set the assessment criteria for PFTs?Recommendation 14: Competency-based criteria for physicians and technicians performing PFTs should be established, encompassing both the quantity and quality of tests. Personnel who do not meet the standards should undergo re-training and re-assessment. (Strong Recommendation)This consensus is registered on the International Practice Guideline Registration and Transparency Platform:PREPARE-2025CN1382 DOI: 10.3760/cma.j.cn112147-20251114-00713.

Pulmonary function tests (PFTs) are performed ahead of listing for liver transplantation (LT) to assess respiratory fitness for transplantation. We aimed to establish whether pre-transplant PFTs were associated with post-LT overall survival and respiratory cause of death. A single-center retrospective study of patients transplanted between 2014 and 2023 was performed. Cox regression was used to analyze the relationship between PFT parameters, normalized for age, sex, ethnicity, and overall post-transplant survival. Competing risks regression was used to analyze the relationship between PFT parameters and respiratory death post-LT. Pre-transplant PFTs from 772 LT recipients were studied (33% female, median age 58 y, indication for transplant: alcohol-associated liver disease in 28.3%, metabolic dysfunction-associated steatotic liver disease in 18.0%). When combined with clinical variables, PFT parameters were predictive of post-transplant overall survival and respiratory death. Lower forced expiratory volume in 1 second (FEV1) (aHR 0.85, 95% CI 0.73-0.99, p =0.04), increased age at transplant (aHR 1.03, 95% CI 1.01-1.05, p =0.01), and current smoking at time of assessment (aHR 1.95, 95% CI 1.08-3.54, p =0.03) were independently associated with poorer post-transplant survival. Whereas both single-breath diffusing capacity of the lung (DLCO SB) (aSHR 0.66, 95% CI 0.52-0.82, p <0.001) and increasing age (aSHR 1.08, 95% CI 1.03-1.14, p =0.001) were independent predictors of post-LT respiratory cause of death. In conclusion, a lower FEV1 z -score was independently associated with poorer post-LT overall survival, and a lower DLCO SB z -score was associated with respiratory cause of death post-LT, supporting the routine use of PFTs in pre-liver transplant assessment.

Impulse oscillometry system (IOS) is an effort-independent pulmonary function testing technique that assesses respiratory system mechanics during tidal breathing and has gained increasing interest as a complementary modality to traditional pulmonary function tests (PFTs), while its physiological relevance and clinical role alongside conventional tests remain incompletely defined. This narrative literature review synthesises evidence on the correlations between IOS parameters and traditional PFT indices, summarises clinical applications across major chronic respiratory diseases, and discusses emerging developments including artificial intelligence-based approaches; the review is based on studies published since 2010 that compare IOS with spirometry, body plethysmography, and diffusing capacity of the lung for carbon monoxide (DLCO) in chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD). Correlation studies indicate that IOS resistance-related parameters are more closely associated with obstructive ventilatory impairment, particularly in COPD and asthma, whereas reactance-related parameters show stronger associations with restrictive ventilatory abnormalities, lung volumes, and diffusion impairment, especially in ILD. Across disease entities, R5-20 and resonant frequency consistently demonstrate higher sensitivity for detecting small airway dysfunction. Clinically, IOS provides value in assessing bronchodilator responsiveness, evaluating asthma control, detecting small airway involvement when spirometry is preserved, and monitoring exposure-related airway effects. Artificial intelligence-based models integrating multidimensional IOS data further highlight its potential in disease screening and classification. Overall, IOS provides complementary physiological and clinical information beyond traditional PFTs, and further large-scale, multicentre studies and methodological standardisation are needed to support its broader clinical implementation.