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(Chest. 2006;130:493-499.)
© 2006 American College of Chest Physicians

Interpreting Periodic Lung Function Tests in Individuals*

The Relationship Between 1- to 5-Year and Long-term FEV1 Changes

Mei Lin Wang, MD, MPH; Bipin H. Avashia, MD and Edward L. Petsonk, MD, FCCP

* From the Division of Respiratory Disease Studies (Drs. Wang and Petsonk), National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV; and Medical Department (Dr. Avashia), Bayer CropScience, Charleston, WV.

Correspondence to: Edward L. Petsonk, MD, FCCP, National Institute for Occupational Safety and Health, Mail Stop H-G900.2, 1095 Willowdale Rd, Morgantown, WV 26505; e-mail: elp2{at}cdc.gov

Abstract

Study objective: Spirometry is performed to monitor lung health, but variability between tests can hinder recognition of excessive FEV1 declines. We sought to describe the relationship between FEV1 changes over 1 to 5 years and FEV1 declines over longer terms, using 21,821 test results from 1,884 workers who participated in an annual health monitoring program at a chemical plant between 1973 and 2003.

Methods: Test results from workers with five or more valid results over ≥ 10 years were included in our analysis (mean initial worker age, 35 years; range, 18 to 62 years; 91% male; 35% current smokers and 41% nonsmokers). For each worker, long-term FEV1 slopes (milliliters per year) were calculated by simple linear regression using all available results and compared to changes in FEV1 between two tests over 1 to 5 years, expressed in both milliliters and percentage of initial value.

Results: Long-term (mean, 18 years; range, 10 to 30 years) slopes averaged – 29.1 mL/yr (– 27, – 29, and – 37 mL/yr for male never-smokers, former smokers, and current smokers, and – 20, – 26, and – 27 mL/yr for female never-smokers, former smokers, and current smokers, respectively). Excessive short-term and long-term declines were defined by lower fifth percentile values. Individuals with abnormal short-term declines were found to be 3 to 18 times more likely to ultimately show excessive long-term declines; with the strength of the association increasing with the length of the short-term testing interval. Better test operating characteristics resulted if abnormal short-term FEV1 change was based on percentage change (ie, percentage per year) rather than absolute change (ie, milliliters per year).

Conclusions: Our findings provide guidance for interpreting periodic spirometry results from individuals exposed to respiratory hazards.

Key Words: diagnostic tests • routine spirometry • sensitivity • specificity






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