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
References (30)
- et al.
Not 15 but 50% of smokers develop COPD! Report from the Obstructive Lung Disease in Northern Sweden Studies.
Respir Med
(2003) Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles.
Chest
(2005)- et al.
Airway obstruction in never smokers: results from the Third National Health and Nutrition Examination Survey.
Am J Med
(2005) - et al.
Discriminating measures and normal values for expiratory obstruction.
Chest
(2006) - et al.
Difficulties identifying and targeting COPD and population-attributable risk of smoking for COPD.
Chest
(2005) - et al.
Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program.
Chest
(2000) - et al.
FEV1/FEV6and FEV6as an alternative for FEV1/FVC and FVC in the spirometric detection of airway obstruction and restriction.
Chest
(2005) - et al.
Assessment of ventilatory abnormality in the asymptomatic subject: an exercise in futility.
Thorax
(1966) - et al.
Predicted values: how should we use them?
Thorax
(1988) - et al.
ATS/ERS task force: standardization of lung function testing: interpretative strategies for lung function tests.
Eur Respir J
(2005)
Global strategies for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.
Am J Respir Crit Care Med
Standards for diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.
Eur Respir J
Population impact of different definition of airway obstruction.
Eur Respir J
COPD in Japan: the Nippon COPD Epidemiology study.
Respirology
Cited by (0)
Support was provided by the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.
There is no financial support or author involvement with organizations with financial interest in the subject matter.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).