Interpreting lung function data using 80% predicted and fixed thresholds identifies patients at increased risk of mortality
- PMID: 21659434
- DOI: 10.1378/chest.11-0797
Interpreting lung function data using 80% predicted and fixed thresholds identifies patients at increased risk of mortality
Abstract
Background: The GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages for COPD use a fixed ratio of the postbronchodilator FEV(1)/FVC ratio of 0.70 as a threshold to define obstruction. Others advocate using the lower limit of normal (LLN) for the FEV(1)/FVC ratio, FEV(1), and FVC to define abnormality. This study investigated mortality in a representative sample of the US adult population with COPD by comparing abnormality determined using GOLD criteria to that determined using LLN criteria.
Methods: We used baseline data from the Third National Health and Nutrition Examination Survey and follow-up mortality data. We classified subjects as obstructed, restricted, or normal based on GOLD vs LLN criteria and used Cox proportional hazards models to determine the relation between lung function impairment and mortality, adjusting for covariates.
Results: The study sample included 13,847 subjects, of whom 3,774 died during the follow-up period. Of subjects classified as obstructed and restricted using GOLD criteria, 20.9% and 18.0%, respectively, were classified as normal using LLN criteria. Compared with people with normal lung function, mortality was increased in the obstructed (hazard ratio, 1.46; 95% CI, 1.21-1.86) and restricted (hazard ratio, 1.94; 95% CI, 1.58-2.39) subjects classified as normal using the LLN.
Conclusions: In the nationally representative Third National Health and Nutrition Examination Survey data, subjects classified as normal using LLN criteria but obstructed or restricted using GOLD criteria have a higher risk of mortality.
Comment in
-
Lung function data interpretation.Chest. 2012 Mar;141(3):832-833. doi: 10.1378/chest.11-2718. Chest. 2012. PMID: 22396577 No abstract available.
Similar articles
-
Association between all-cause and cause-specific mortality and the GOLD stages 1-4: A 30-year follow-up among Finnish adults.Respir Med. 2015 Aug;109(8):1012-8. doi: 10.1016/j.rmed.2015.06.002. Epub 2015 Jun 9. Respir Med. 2015. PMID: 26108990
-
Lower limit of normal or FEV1/FVC < 0.70 in diagnosing COPD: an evidence-based review.Respir Med. 2011 Jun;105(6):907-15. doi: 10.1016/j.rmed.2011.01.008. Epub 2011 Feb 5. Respir Med. 2011. PMID: 21295958 Review.
-
Interpreting lung function data using 80% predicted and fixed thresholds misclassifies more than 20% of patients.Chest. 2011 Jan;139(1):52-9. doi: 10.1378/chest.10-0189. Epub 2010 Jun 3. Chest. 2011. PMID: 20522571
-
What defines abnormal lung function in older adults with chronic obstructive pulmonary disease?Drugs Aging. 2008;25(9):717-28. doi: 10.2165/00002512-200825090-00001. Drugs Aging. 2008. PMID: 18729545 Review.
-
Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function?Thorax. 2007 Mar;62(3):237-41. doi: 10.1136/thx.2006.068379. Epub 2006 Nov 7. Thorax. 2007. PMID: 17090573 Free PMC article.
Cited by
-
GOLD 2024: a brief overview of key changes.J Bras Pneumol. 2023 Dec 22;49(6):e20230369. doi: 10.36416/1806-3756/e20230369. J Bras Pneumol. 2023. PMID: 38126685 Free PMC article. No abstract available.
-
Comparison of the lower limit of normal to the fixed ratio method for the diagnosis of airflow obstruction at high altitudes: a large cross-sectional survey of subjects living between 3000-4700 m above sea level.Eur J Med Res. 2023 Jun 12;28(1):189. doi: 10.1186/s40001-023-01151-1. Eur J Med Res. 2023. PMID: 37309013 Free PMC article.
-
[Lung function test in advanced age].Z Gerontol Geriatr. 2022 Nov;55(7):603-612. doi: 10.1007/s00391-022-02070-2. Epub 2022 Sep 15. Z Gerontol Geriatr. 2022. PMID: 36104461 German.
-
Evaluating the Relationship of Airflow Obstruction in COPD with Severity of OSA Among Patients with Overlap Syndrome.Int J Chron Obstruct Pulmon Dis. 2022 Jul 14;17:1613-1621. doi: 10.2147/COPD.S355897. eCollection 2022. Int J Chron Obstruct Pulmon Dis. 2022. PMID: 35860813 Free PMC article.
-
Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study.Respir Res. 2022 May 31;23(1):140. doi: 10.1186/s12931-022-02057-y. Respir Res. 2022. PMID: 35641974 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical