New software for assessment and interpretation of pulmonary function tests in adults

Abstract

This study evaluated the concordance of a new automated interpretation software (DrPFT©: Doctor Pulmonary Function Test) with expert guideline-based interpretation of PFTs. This non-interventional study included a prospective cohort of 1,819 adult Tunisian participants who underwent complete PFT in outpatient and hospital settings in 2025 by a panel of five experienced pulmonologists (n=3) and physiologists (n=2) using the standardized American Thoracic Society and the European Respiratory Society (ATS/ERS) interpretative criteria. A consensus classification was established for ventilatory patterns (normal, obstructive, restrictive, or mixed). The same datasets were subsequently analyzed by the DrPFT©, which implements ATS/ERS interpretative algorithms in an automated manner. Diagnostic concordance between DrPFT© and expert interpretation was assessed using sensitivity, specificity, positive and negative predictive values, with ATS/ERS-based expert consensus serving as the reference standard. Based upon the ATS/ERS criteria, 26.0% of participants were classified as normal, 25.8% restrictive, 26.4% obstructive, 9.4% mixed, and 12.4% nonspecific ventilatory pattern. When compared with the ATS/ERS reference, pulmonologists/physiologists demonstrated high sensitivity across all classical patterns (90.7–94.2%) and high specificity, particularly for restrictive (99.3%) and mixed (98.0%) defects. DrPFT© showed similarly robust performance, with sensitivities ranging from 88.6% to 93.6% and specificities exceeding 97% for restrictive and mixed ventilatory patterns. Direct comparison revealed excellent agreement between DrPFT© and expert interpretation, with sensitivity 93.6% and specificity >98% across all categories. Sensitivity was comparable between DrPFT© and expert interpretation for restrictive, obstructive, and mixed patterns (all p > 0.050), whereas a small but statistically significant difference was observed for the classification of healthy participants which was higher by the experts (88.6% vs. 90.7%, respectively; p = 0.002). DrPFT© provides automated ATS/ERS guideline-based interpretation of ventilatory patterns using spirometry and lung volume measurements, with a level of concordance comparable to expert readers. Although the software also incorporates interpretation of carbon monoxide diffusing capacity (DLCO), this component was not formally validated in the present study because of insufficient data. By standardizing the application of ATS/ERS interpretative criteria, this decision-support system may improve the consistency and efficiency of routine PFT reporting, particularly in settings with limited access to specialized expertise.