Slow vital capacity

Shruti Singh, Sara Z. Khan, Bhakti Patel, Rammohan Gumpeni, Sameer Verma, Arunabh Talwar


Forced vital capacity (FVC) and slow vital capacity (SVC) are non-invasive tests of respiratory function. Although FVC has been extensively studied and is used in most PFT (pulmonary function test) labs, SVC can also be used in clinical practice as it is a more comfortable and convenient test to perform. SVC-based diagnostic criteria can lead to earlier detection of obstructive lung disease. In contrast to FVC, SVC is less affected by respiratory muscle fatigue, airflow patency, expiratory muscle weakness and air leakage making it an appropriate test of respiratory function in patients of amyotrophic lateral sclerosis (ALS) and other neuromuscular disorders. As respiratory insufficiency is the major cause of mortality in ALS patients, regular SVC measurement provides the respiratory functional status, so that early treatment can be started which improves the survival and quality of life in these patients. The purpose of this article is to highlight the importance of considering SVC in clinical practice.


Forced vital capacity, Slow vital capacity, Amyotrophic lateral sclerosis, Obstructive lung disease, Pulmonary function test

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Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-68.

Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26:511-22.

Chhabra SK. Forced vital capacity, slow vital capacity, or inspiratory vital capacity: which is the best measure of vital capacity? J Asthma. 1998;35:361-5.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319-38.

Jackson C, De Carvalho M, Genge A, Heiman-Patterson T, Shefner JM, Wei J et al. Relationships between slow vital capacity and measures of respiratory function on the ALSFRS-R. Amyotroph Lateral Scler Frontotemporal Degener. 2018;19:506-12.

Cohen J, Postma DS, Vink-Klooster K, Van der Bij W, Verschuuren E, Ten Hacken NH et al. FVC to slow inspiratory vital capacity ratio: a potential marker for small airways obstruction. Chest. 2007;132:1198-203.

Barros AR, Pires MB, Raposo NM. Importance of slow vital capacity in the detection of airway obstruction. J Bras Pneumol. 2013;39:317-22.

Sahebjami H, Gartside PS. Pulmonary function in obese subjects with a normal FEV1/FVC ratio. Chest. 1996;110:1425-9.

Saint-Pierre M, Ladha J, Berton DC, Reimao G, Castelli G, Marillier M et al. Is the Slow Vital Capacity Clinically Useful to Uncover Airflow Limitation in Subjects with Preserved FEV1/FVC Ratio? Chest. 2019;156(3):497-506.

Fortis S, Corazalla EO, Wang Q, Kim HJ. The difference between slow and forced vital capacity increases with increasing body mass index: a paradoxical difference in low and normal body mass indices. Respir Care. 2015;60:113-8.

Bubis MJ, Sigurdson M, McCarthy DS, Anthonisen NR. Differences between slow and fast vital capacities in patients with obstructive disease. Chest. 1980;77:626-31.

Chan ED, Irvin CG. The detection of collapsible airways contributing to airflow limitation. Chest. 1995;107:856-9.

Berton DC, Neder JA. Measuring slow vital capacity to detect airflow limitation in a woman with dyspnea and a preserved FEV1/FVC ratio. J Bras Pneumol. 2019;45:e20190084.

Simonsson BG. Dynamic Spirometry Studies in Patients with Lung Disease. Iii. Comparison between Slow and Forced Vital Capacities. Acta Allergol. 1963;18:353-64.

O'Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax. 2000;55:635-42.

Huprikar NA, Skabelund AJ, Bedsole VG, Sjulin TJ, Karandikar AV, Aden JK et al. Comparison of the Forced and Slow Vital Capacity Maneuvers in Defining Airway Obstruction. Respir Care. 2019.

Lalley PM. The aging respiratory system--pulmonary structure, function and neural control. Respir Physiol Neurobiol. 2013;187:199-210.

Pinto S, De Carvalho M. Comparison of slow and forced vital capacities on ability to predict survival in ALS. Amyotroph Lateral Scler Frontotemporal Degener. 2017;18:528-33.

Pinto S, De Carvalho M. SVC Is a Marker of Respiratory Decline Function, Similar to FVC, in Patients With ALS. Front Neurol. 2019;10:109.

Lechtzin N, Cudkowicz ME, De Carvalho M, Genge A, Hardiman O, Mitsumoto H et al. Respiratory measures in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2018;19:321-30.

Pinto S, De Carvalho M. Correlation between Forced Vital Capacity and Slow Vital Capacity for the assessment of respiratory involvement in Amyotrophic Lateral Sclerosis: a prospective study. Amyotroph Lateral Scler Frontotemporal Degener. 2017;18:86-91.

Gordon PH. Amyotrophic Lateral Sclerosis: An update for 2013 Clinical Features, Pathophysiology, Management and Therapeutic Trials. Aging Dis. 2013;4:295-310.

Pinto S, Carvalho M. Breathing new life into treatment advances for respiratory failure in amyotrophic lateral sclerosis patients. Neurodegener Dis Manag. 2014;4:83-102.

Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73:1218-26.

Corcia P, Pradat PF, Salachas F, Bruneteau G, Forestier N, Seilhean D et al. Causes of death in a post-mortem series of ALS patients. Amyotroph Lateral Scler. 2008;9:59-62.

De Carvalho M, Matias T, Coelho F, Evangelista T, Pinto A, Luis ML. Motor neuron disease presenting with respiratory failure. J Neurol Sci. 1996;139:117-22.

Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006;5:140-7.

Miller RG, Rosenberg JA, Gelinas DF, Mitsumoto H, Newman D, Sufit R et al. Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurol. 1999;52:1311-23.

Diagnosis ETFo, Management of Amyotrophic Lateral S, Andersen PM, Abrahams S, Borasio GD, de Carvalho M, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force. Eur J Neurol. 2012;19:360-75.

Fallat RJ, Jewitt B, Bass M, Kamm B, Norris FH, Jr. Spirometry in amyotrophic lateral sclerosis. Arch Neurol. 1979;36:74-80.

Czaplinski A, Yen AA, Appel SH. Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population. J Neurol Neurosurg Psychiatry. 2006;77:390-2.

Pinto S, Turkman A, Pinto A, Swash M, De Carvalho M. Predicting respiratory insufficiency in amyotrophic lateral sclerosis: the role of phrenic nerve studies. Clin Neurophysiol. 2009;120:941-6.

Baumann F, Henderson RD, Morrison SC, Brown M, Hutchinson N, Douglas JA et al. Use of respiratory function tests to predict survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2010;11:194-202.

Ringel SP, Murphy JR, Alderson MK, Bryan W, England JD, Miller RG et al. The natural history of amyotrophic lateral sclerosis. Neurol. 1993;43:1316-22.

Lechtzin N, Wiener CM, Shade DM, Clawson L, Diette GB. Spirometry in the supine position improves the detection of diaphragmatic weakness in patients with amyotrophic lateral sclerosis. Chest. 2002;121:436-42.

Schiffman PL, Belsh JM. Pulmonary function at diagnosis of amyotrophic lateral sclerosis. Rate of deterioration. Chest. 1993;103:508-13.

Andrews JA, Meng L, Kulke SF, Rudnicki SA, Wolff AA, Bozik ME et al. Association Between Decline in Slow Vital Capacity and Respiratory Insufficiency, Use of Assisted Ventilation, Tracheostomy, or Death in Patients with Amyotrophic Lateral Sclerosis. JAMA Neurol. 2018;75:58-64.

Paillisse C, Lacomblez L, Dib M, Bensimon G, Garcia-Acosta S, Meininger V. Prognostic factors for survival in amyotrophic lateral sclerosis patients treated with riluzole. Amyotroph Lateral Scler Other Motor Neuron Disord. 2005;6:37-44.

Gil J, Preux PM, Alioum A, Ketzoian C, Desport JC, Druet-Cabanac M et al. Disease progression and survival in ALS: first multi-state model approach. Amyotroph Lateral Scler. 2007;8:224-9.

Chrismer I, Witherspoon J, Drinkard B, Stockman M, Shelton M, Kuo A et al. P.54 Forced and slow vital capacities in RYR1-RM. Neuromuscular Disorders. 2018;28:S47.

Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197-205.

Constán EMJ, Silvestre A, Alvarez I, Olivas R. Difference between the slow vital capacity and forced vital capacity: predictor of hyperinflation in patients with airflow obstruction. Internet J Pulm Med. 2005;4:1.

Nesterovska OSG, Stupnytska A. Evaluation of Slow Vital capacity and Forced Vital Capacity in patients with COPD. Eur Respir J. 2018;52:748.

Yuan W, He X, Xu QF, Wang HY, Casaburi R. Increased difference between slow and forced vital capacity is associated with reduced exercise tolerance in COPD patients. BMC Pulm Med. 2014;14:16.

Wenzel SE, Schwartz LB, Langmack EL, Halliday JL, Trudeau JB, Gibbs RL et al. Evidence that severe asthma can be divided pathologically into two inflammatory subtypes with distinct physiologic and clinical characteristics. Am J Respir Crit Care Med. 1999;160:1001-8.

Rasheed AVV, Shahzad S, Arjomand DM, Reminick S. Underdiagnosis of obstructive disease by spirometry. Chest. 2011;140:691.

Toren K, Olin AC, Lindberg A, Vikgren J, Schioler L, Brandberg J et al. Vital capacity and COPD: the Swedish CArdioPulmonary bioImage Study (SCAPIS). Int J Chron Obstruct Pulmon Dis. 2016;11:927-33.

Nathell L, Nathell M, Malmberg P, Larsson K. COPD diagnosis related to different guidelines and spirometry techniques. Respir Res. 2007;8:89.

Saravanan MRP, Rajarajeswari K. Which is better among FEV1/FVC and FEV1/SVC in obstructive airway disease? Int J Adv Med. 2018;5:1328-30.

Martinez L, Rodrigues D, Donaria L, Furlanetto KC, Machado FVC, Schneider LP et al. Difference Between Slow and Forced Vital Capacity and Its Relationship with Dynamic Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease. Lung. 2019;197:9-13.