Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a pulmonologist, you are responsible for examining Pam, ordering tests and procedures and diagnosing her condition. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Internet Research: You review Pam’s EHR and initial spirometry results, which indicate * FEV₁/FVC < 0.7; * 50% ≤ FEV₁ < 80% predicted. Using the Global Initiative for Obstructive Lung Disease (GOLD) staging system, determine what these results signify.



2. Review Pam’s Outpatient EHR: You also notice that Pam’s oxygen saturation (SpO₂) is low (as indicated in blue). What is Pam’s SpO₂?
   
   Internet Research: How is oxygen saturation (SpO₂) measured?
   
   Internet Research: What causes low SpO2 (also referred to as hypoxemia)?



3. Review Pam’s VPE: You ask Pam to use her bronchodilator and then perform another spirometry test—the results are similar. You decide to have her complete the remaining pulmonary function tests and order a pulmonary plethysmography and diffusing capacity (DLCO) test. Using VPE, explain these tests.
   
   Review Pam’s VPE: What do Pam’s results indicate?



4. Internet Research: You order an arterial blood gas test (ABG). What is the purpose of this test?