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Restriction with Normal Spirometry: A Retrospective Cohort Study.

Alexander T Moffett1,2,3, Aparna Balasubramanian4, Meredith C McCormack4

  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Medrxiv : the Preprint Server for Health Sciences
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Restriction with normal spirometry, a condition where lung function tests appear normal but show underlying restriction, is common. This condition is linked to interstitial lung disease and reduced survival rates, indicating significant ventilatory impairments.

Keywords:
pulmonary function test interpretationrestrictionspirometry

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology
  • Diagnostic Imaging

Background:

  • Normal spirometry is often assumed to indicate the absence of lung restriction.
  • Emerging evidence suggests that lung restriction may be prevalent even with normal spirometry results.
  • The clinical implications of lung restriction in patients with normal spirometry remain unclear.

Purpose of the Study:

  • To investigate the clinical characteristics associated with lung restriction in patients exhibiting normal spirometry.
  • To determine the impact of lung restriction with normal spirometry on patient survival outcomes.

Main Methods:

  • Analysis of pulmonary function tests (PFTs), including static and dynamic lung volumes, from 2012-2025.
  • Multivariable logistic regression to identify factors associated with restriction in normal spirometry.
  • Cox proportional hazards modeling to assess the association between restriction and all-cause mortality, adjusting for key spirometric parameters.

Main Results:

  • A significant prevalence of restriction (25.7%) was found among patients with normal spirometry.
  • Restriction was more common in older, non-White patients, and those with interstitial lung disease (ILD).
  • Restriction was associated with increased all-cause mortality (aHR 1.45) compared to normal spirometry without restriction.

Conclusions:

  • Lung restriction in patients with normal spirometry is associated with interstitial lung disease (ILD).
  • This condition is linked to a decreased survival rate.
  • Clinically significant ventilatory impairments can be present even when spirometry results appear normal.