Exercise testing in the assessment of impairment/disability

The chest physician is responsible for the assessment of impairment and disability, as separate entities, in patients with pulmonary disease. The conceptual framework introduced by the World Health Organization (WHO) should be formally adopted for the evaluation of impairment (loss of function), disability (reduction in exercise capacity); and, handicap (the impact of the illness on the subject's social life) in claimants with pulmonary disorders. The practice of equating exercise capacity (disability) to peak oxygen consumption (V'O2,peak) is generally accepted. Also measurement of oxygen consumption (V'O2) uptake at a constant work rate submaximal to V'O2,peak to identify the level of work rate sustainable for a long period of time has been suggested as a useful tool for the assessment of work ability and/or compensation for work inability. Patient's physical deconditioning, specific characteristics of the tasks to be done, motivation and other reported modifying conditions should be taken into account for an appropriate rating of disability in a given individual.