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Spirometric Criteria for Airway Obstruction^*

Use Percentage of FEV₁/FVC Ratio Below the Fifth Percentile, Not < 70%

^* From the Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.

Correspondence to: James E. Hansen, MD, FCCP, Box 405, Harbor-UCLA Medical Center, Torrance, CA 90509; e-mail: jhansen{at}labiomed.org

Abstract

Background: Current authoritative spirometry guidelines use conflicting percentage of FEV₁/FVC ratios (FEV₁/FVC%) to define airway obstruction. The American Thoracic Society/European Respiratory Society Task Force characterizes obstruction as a FEV₁/FVC% below the statistically defined fifth percentile of normal. However, many recent publications continue to use the Global Initiative for Chronic Obstructive Lung Disease (GOLD) primary criterion that defines obstruction as a FEV₁/FVC% < 70%. Data from the Third National Health and Nutrition Examination Survey (NHANES-III) should identify and quantify differences, help resolve this conflict, and reduce inappropriate medical and public health decisions resulting from misidentification.

Methods: Using these two guidelines, individual values of FEV₁/FVC% were compared by decades in 5,906 healthy never-smoking adults and 3,497 current-smokers of black (African American), Hispanic (Latin), or white ethnicities aged 20.0 to 79.9 years.

Results: In the never-smoking population, the lower limits of normal used in other reference equations fit reasonably well the NHANES-III statistically defined fifth percentile guidelines. But nearly one half of young adults with FEV₁/FVC% below the NHANES-III fifth percentile of normal were misidentified as normal because their FEV₁/FVC% was > 70% (abnormals misidentified as normal). Approximately one fifth of older adults with observed FEV₁/FVC% above the NHANES-III fifth percentile had FEV₁/FVC% ratios < 70% (normals misidentified as abnormal).

Conclusions: The GOLD guidelines misidentify nearly one half of abnormal younger adults as normal and misidentify approximately one fifth of normal older adults as abnormal.

Key Words: airway obstruction • percentage of predicted FEV₁/FVC • reference values • spirometry

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