**7. Diagnostic evaluation**

#### **Pulmonary function tests**

Spirometry is a common diagnostic way for staging the severity of pulmonary impairment. Like to COPD due to other causes, generally an obstructive pattern is present in patients. A study showed that FEV1 is decreased at a rate of 50 ml/year in mustard lung patients (11, 33).

In body plethysmography, total lung capacity (TLC) and residual volume (RV) are markedly increased and Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) remains normal (11, 34).

#### **Chest x-ray**

Since the majority of mustard lung patients have normal or near normal chest x-ray (CXR) , some authors believe that CXR is not a reliable diagnostic imaging modality in these patients (12,35). Increased bronchovascular markings, and hyperinflation, pulmonary hypertension can be seen in CXR (12, 36).

#### **HRCT**

Chest HRCT has became a imaging modality of choice in SM patients (12).Air trapping and airway abnormal wall thickening are the most common HRCT finding (12,37).

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