[Annual advances in clinical applications of pulmonary function testing 2025]

This review systematically synthesizes and critically appraises domestic and international advances in pulmonary function tests (PFT) research and clinical applications between October 2024 and September 2025. Three major Chinese guidelines or expert consensuses on PFT were published, including the Chinese expert consensus on the testing process and clinical application of fractional exhaled nitric oxide detector (2025), Expert consensus on pediatric lung diffusing capacity tests, and the Chinese guideline for routine pulmonary function tests in primary care (2024). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 report was published, alongside its Chinese version of teaching slides and pocket guideline. Key recommendations reviewed and interpreted include the workflow for pre-and post-bronchodilator spirometry recommended by GOLD science committee, PFT criteria for defining airflow obstruction, guidance on interpreting reference values, the classification of airflow obstruction severity, and a life-course trajectory chart illustrating lifespan changes in pulmonary function. This trajectory illustrates that forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) increase rapidly initially, then more slowly to a peak, followed by a progressive decline without a plateau phase. In contrast, the FEV1/FVC ratio trajectory demonstrates a gradual decline starting from the age of 4. Regarding reference equations, researchers conducted more in-depth verification and reflection, and numerous studies have found that applying the Global Lung Initiative (GLI) Global equation may lead to overestimation or underestimation of pulmonary function in diverse ethnic populations. Significant progress has been made in China with the establishment of spirometric reference equations tailored for children and populations residing in high-altitude regions, providing an important tool for precise assessment of these groups. In terms of technological integration, PFT is becoming deeply integrated with various advanced technologies. Electrical Impedance Tomography shows promise for early detection of lung function abnormalities. Chest CT imaging is increasingly being utilized to predict functional parameters. Furthermore, strong correlations have been identified between PFT results and findings from lung ultrasound as well as specific laboratory markers, including albumin, non-high-density lipoprotein cholesterol, and serum β-catenin. Advances in artificial intelligence are particularly noteworthy in the field of pulmonary function. Researchers have developed sophisticated AI models capable of not only predicting lung function outcomes but also utilizing pulmonary function testing parameters to forecast the likelihood of various diseases. These tools significantly enhance clinicians' diagnostic accuracy and efficiency. Regarding technical equipment, several domestically produced devices have been successfully developed and introduced to the market in China. These include forced oscillation technique instruments, fractional exhaled nitric oxide analyzers employing chemiluminescence and electrochemical detection methods, and oscillatory resistance bronchial provocation test systems. The widespread adoption of these devices has lowered the technological threshold and enhanced the accessibility of services. Collectively, these research outcomes and technological innovations provide clinicians and researchers with up-to-date scientific and practical guidance, significantly propelling the advancement and clinical application of PFT.