Underestimation of airflow obstruction among young adults using FEV[sub1]/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes

Cerveri, I.; Corsico, A. G.; Accordini, S.; Niniano, R.; Ansaldo, E.; Antó, J. M.; Künzli, N.; Janson, C.; Sunyer, J.; Jarvis, D.; Svanes, C.; Gislason, T.; Heinrich, J.; Schouten, J. P.; Wjst,10, M.; Burney, P.; De Marco, R.
December 2008
Thorax;Dec2008, Vol. 63 Issue 12, p1040
Academic Journal
Background: Early detection of airflow obstruction is particularly important among young adults because they are more likely to benefit from intervention. Using the forced expiratory volume in 1 s (FEV[sub1]) to forced vital capacity (FVC) (FEV[sub1]/FVC( <70% fixed ratio, airflow obstruction may be underdiagnosed. The lower limit of normal )LLN), which is statistically defined by the lower fifth percentile of a reference population, is physiologically appropriate but it still needs a clinical validation. Methods: To evaluate the characteristics and longitudinal outcomes of subjects misidentified as normal by the fixed ratio with respect to the LLN, 6249 participants (aged 20-44 years) in the European Community Respiratory Health Survey were examined and divided into three groups (absence of airflow obstruction by the LLN and the fixed ratio; presence of airflow obstruction only by the LLN; presence of airflow obstruction by the two criteria) for 1991-1993. LLN equations were obtained from normal non-smoking participants. A set of clinical and functional outcomes was evaluated in 1999-2002. Results: The misidentified subjects were 318 (5.1%); only 45.6% of the subjects with airflow obstruction by the LLN were also identified by the fixed cut-off. At baseline, FEV[sub1] (107%, 97%, 85%) progressively decreased and bronchial hyperresponsiveness (slope 7.84, 6.32, 5.57) progressively increased across the three groups. During follow-up, misidentified subjects had a significantly higher risk of developing chronic obstructive pulmonary disease and a significantly higher use of health resources (medicines, emergency department visits/hospital admissions) because of breathing problems than subjects without airflow obstruction (p<0.001). Conclusions: Our findings show the importance of using statistically derived spirometric criteria to identify airflow obstruction.


Related Articles

  • The Relationship between Δ-Forced Vital Capacity (Percent Fall in Forced Vital Capacity at the PC20 Dose of Methacholine) and the Maximal Airway Response in Patients Who Have Mild Asthma. Jinho Yu; Young Yoo; Do Kyun Kim; Young Yull Koh // Allergy & Asthma Proceedings;Sep/Oct2005, Vol. 26 Issue 5, p366 

    Airway hypersensitivity is routinely evaluated by measuring the concentration (PC20) of inhaled methacholine or histamine that causes a 20% fall in forced expiratory volume in 1 second (FEV1). It has been suggested that a percentage fall in forced vital capacity (FVC) measured at the PC20 dose...

  • Soluble receptor for advanced glycation end-products and progression of airway disease. Iwamoto, Hiroshi; Gao, Jing; Pulkkinen, Ville; Toljamo, Tuula; Nieminen, Pentti; Mazur, Witold // BMC Pulmonary Medicine;2014, Vol. 14 Issue 1, p1 

    Background The receptor for advanced glycation end-products (RAGE) is highly expressed in the lung, where it is believed to have a homeostatic role. Reduced plasma levels of soluble RAGE (sRAGE) have been reported in patients with chronic obstructive pulmonary disease (COPD). The aim of the...

  • Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China: cluster randomised controlled trial. Yumin Zhou; Guoping Hu; Dali Wang; Shaoyi Wang; Yujun Wang; Zhigang Liu; Jinxin Hu; Zhe Shi; Gongyong Peng; Shengming Liu; Jiachun Liu; Jingping Zheng; Jian Wang; Nanshan Zhong; Pixin Ran // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;12/4/2010, Vol. 341 Issue 7784, p1203 

    The article focuses on a study which analyzed if community based integrated interventions have an effect on early prevention and management of chronic pulmonary disease (COPD), especially the annual rate of decline in forced expiratory volume in one second (FEV1). Study participants, aged 40-89...

  • Closing volume: a reappraisal (1967-2007). Milic-Emili, Joseph; Torchio, Roberto; D'Angelo, Edgardo // European Journal of Applied Physiology;Apr2007, Vol. 99 Issue 6, p567 

    Measurement of closing volume (CV) allows detection of presence or absence of tidal airway closure, i.e. cyclic opening and closure of peripheral airways with concurrent (1) inhomogeneity of distribution of ventilation and impaired gas exchange; and (2) risk of peripheral airway injury. Tidal...

  • Theatre-based hospital placements for firefighters. Durmaz, Emma // British Journal of Perioperative Nursing;Sep2005, Vol. 15 Issue 9, p396 

    Airway obstruction is the most common cause of death in the pre-hospital environment. It is estimated that 85% of these patients had otherwise survivable injuries. The aim of the project was to increase firefighters' skills in airway management techniques, to include the laryngeal mask airway...

  • Flow-Volume Parameters in COPD Related to Extended Measurements of Lung Volume, Diffusion, and Resistance. Jarenbäck, Linnea; Ankerst, Jaro; Bjermer, Leif; Tufvesson, Ellen // Pulmonary Medicine;2013, p1 

    Classification of COPD into different GOLD stages is based on forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) but has shown to be of limited value. The aim of the study was to relate spirometry values to more advanced measures of lung function in COPD patients compared to...

  • Is There a Role for Screening Spirometry? MacIntyre, Neil R.; Selecky, Paul A. // Respiratory Care;Jan2010, Vol. 55 Issue 1, p35 

    In obstructive lung disease, the characteristic change in spirometry is a reduction in the forced expiratory volume in the first second (FEV1) with respect to the vital capacity. Moreover, the severity of the obstruction can be graded by referencing spirometric measurements to age, sex, and...

  • Pulmonary function tests and impulse oscillometry in severe chronic obstructive pulmonary disease patients' offspring. Amra, Babak; Borougeni, Victoria Beigi; Golshan, Mohammad; Soltaninejad, Forogh // Journal of Research in Medical Sciences;Jul2015, Vol. 20 Issue 7, p697 

    Background: Several studies have showed an increased prevalence of airflow obstruction in first degree relatives of individuals with chronic obstructive pulmonary disease (COPD). Considering no specific research had evaluated airway resistance in off spring of patients with severe COPD, we...

  • Comparison of the effects of salmeterol/fluticasone propionate with fluticasone propionate on airway physiology in adults with mild persistent asthma. Houghton, Catherine M.; Lawson, Naomi; Borrill, Zoe L.; Wixon, Claire L.; Yoxall, Sally; Langley, Stephen J.; Woodcock, Ashley; Singh, Dave // Respiratory Research;2007, Vol. 8, p52 

    Background: This study compared the effect of inhaled fluticasone propionate (FP) with the combination of salmeterol/fluticasone propionate (SFC) on lung function parameters in patients with mild asthma. Methods: Adult patients with mild persistent asthma (≥ 80% predicted FEV1) receiving...


Read the Article


Sign out of this library

Other Topics