Chest
Original ResearchSpirometric Criteria for Airway Obstruction: Use Percentage of FEV1/FVC Ratio Below the Fifth Percentile, Not < 70%
Section snippets
Subjects
Subjects were 5,906 never-smoking adults without recognized respiratory or musculoskeletal disease and 3,497 current-smoking adults from the Third National Health and Nutrition Examination Survey (NHANES-III) database16from ages 20.0 to 79.9 years (third to eighth decades). Each subject selected (Table 1) was classified ethnically as black, Latin, or white, and had performed repeated spirometric maneuvers meeting ATS standards.15, 16These data from unidentified subjects had been ethically
Results
The percentage of NHANES-III never-smokers with FEV1/FVC% < 70% are shown by decade of age, sex, and ethnicity inFigure 1,top,A. For each group, the prevalence was < 5% for the third and fourth decades; thereafter, it increased to 6 to 14% for the sixth decade, 11 to 18% for the seventh decade, and 19 to 33% for the eighth decade. If ethnic- and sex-specific groups were weighted equally, mean values for the third through eighth decades, respectively, were 2.0%, 2.6%, 4.7%, 8.3%, 14.6%, and
Discussion
This study illustrates the importance of using statistically valid spirometric criteria to identify the prevalence of airway obstruction. Use of the GOLD criterion to identify obstruction as an FEV1/FVC% < 70% results in finding an inappropriately high prevalence of obstruction in adults in seventh and eighth decades, among never-smokers and probably among current-smokers. Confirmatory evidences in these decades are the relatively low specificity and very low PPV(Table 3)and high ratios of
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2020, ChestCitation Excerpt :As to GOLD-based criteria, prior work has already established misclassification across the continuum of lung function and in aging populations.1-11,21-25,36 In particular, the GOLD threshold of 0.70 for FEV1/FVC does not account for the age-related decline in lung function, thus misclassifying normal-for-age spirometry, restrictive-pattern, and airflow obstruction.1-11,21-25 Moreover, because it does not account for the age-related increased variability in spirometric performance (wider range of normal), the GOLD FEV1 %Pred thresholds misclassify the severity of airflow obstruction, assuming incorrectly that a given value is equivalently low or high across the adult lifespan.3-10,22,23,36
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Support was provided by the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.
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