Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes.

2.50
Hdl Handle:
http://hdl.handle.net/2336/46843
Title:
Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes.
Authors:
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, M; Burney, P; de Marco, R
Citation:
Thorax 2008, 63(12):1040-5
Issue Date:
1-Dec-2008
Abstract:
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(1)) to forced vital capacity (FVC) (FEV(1)/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(1) (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.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://thorax.bmj.com/cgi/content/abstract/63/12/1040

Full metadata record

DC FieldValue Language
dc.contributor.authorCerveri, I-
dc.contributor.authorCorsico, A G-
dc.contributor.authorAccordini, S-
dc.contributor.authorNiniano, R-
dc.contributor.authorAnsaldo, E-
dc.contributor.authorAntó, J M-
dc.contributor.authorKünzli, N-
dc.contributor.authorJanson, C-
dc.contributor.authorSunyer, J-
dc.contributor.authorJarvis, D-
dc.contributor.authorSvanes, C-
dc.contributor.authorGislason, T-
dc.contributor.authorHeinrich, J-
dc.contributor.authorSchouten, J P-
dc.contributor.authorWjst, M-
dc.contributor.authorBurney, P-
dc.contributor.authorde Marco, R-
dc.date.accessioned2008-12-22T13:51:06Z-
dc.date.available2008-12-22T13:51:06Z-
dc.date.issued2008-12-01-
dc.date.submitted2008-12-22-
dc.identifier.citationThorax 2008, 63(12):1040-5en
dc.identifier.issn1468-3296-
dc.identifier.issn0040-6376-
dc.identifier.pmid18492741-
dc.identifier.doi10.1136/thx.2008.095554-
dc.identifier.urihttp://hdl.handle.net/2336/46843-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: 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(1)) to forced vital capacity (FVC) (FEV(1)/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(1) (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.en
dc.language.isoenen
dc.publisherBritish Medical Assnen
dc.relation.urlhttp://thorax.bmj.com/cgi/content/abstract/63/12/1040en
dc.subject.meshPubMed - in processen
dc.titleUnderestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes.en
dc.typeArticleen
dc.contributor.departmentDivision of Respiratory Diseases, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.en
dc.identifier.journalThoraxen

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