Measurement of various aspects of pulmonary function is a relatively easy, noninvasive, and inexpensive way to gauge the status of the respiratory system. Interest in using these tests to determine risk from medical and surgical interventions stems from their presumed ability to be more sensitive than history or physical examination in detecting underlying lung disease. When coupled with the assumption that early detection of pulmonary abnormalities will lead to alterations in patient management, the ultimate goal of improved patient outcomes becomes very attractive. However, despite advances in technology, achievement of this goal has proved to be more challenging than expected in many areas. This paper attempts to review the literature addressing several of the more difficult of these areas. It is clear that more research, involving more rigorously designed studies, will be necessary, before definitive answers are available.
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