FEV 1 /FVC Ratio of 70% Misclassifies Patients With Obstruction at the Extremes of Age

Roberts, Scott D.; Farber, Mark O.; Knox, Kenneth S.; Phillips, Gary; Bhatt, Nitin; Mastronarde, John G.; Wood, Karen L.

doi:10.1378/chest.130.1.200

Cited by 112 publications

(78 citation statements)

References 10 publications

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“…A FEV1/FVC ratio <0.7 was perceived as 'low' according to guidelines, without automatically implying a diagnosis of COPD, 1 because the ratio physiologically decreases with age. 1,21 A history of smoking was supportive of a diagnosis but not obligatory. COPD severity was defined according to the Global Initiative for Obstructive Pulmonary Disease (GOLD).…”

Section: Reference Test (Diagnostic Outcome)mentioning

confidence: 97%

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Broekhuizen

Sachs²,

Verheij³

et al. 2012

Br J Gen Pract

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Section: Reference Test (Diagnostic Outcome)mentioning

confidence: 97%

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Broekhuizen

Sachs²,

Verheij³

et al. 2012

Br J Gen Pract

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“…In most of these, moreover, especially the older studies, there was no information about post bronchodilator spirometry for subjects with FEV 1 /FVC ratios <0.7. The frequently used GOLD criterion introducing a fixed FEV 1 /FVC of <0.70 is prone to overestimation of obstruction among older or male subjects, while, among the young or female subjects, the GOLD criteria will tend to underestimate the true prevalence because FEV 1 /FVC declines with age as we noted earlier (107). Indeed, defining COPD solely on the criterion of FEV 1 /FVC <0.7 is no longer accepted in the European Respiratory Journal (6).…”

Section: Strengths and Limitationsmentioning

confidence: 98%

Occupational chronic obstructive pulmonary disease: a systematic literature review

Omland

Würtz

Aasen³

et al. 2013

Scand J Work Environ Health

117

100

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Occupational chronic obstructive pulmonary disease: a systematic literature review by Omland Ø, Würtz ET, Aasen TB, Blanc P, Brisman J, Miller MR, Pedersen OF, Schlünssen V, Sigsgaard T, Ulrik CS, Viskum S This review on occupational chronic obstructive pulmonary disease (COPD) addresses some of the potential limitations of earlier assessments by restricting the studies included to high quality epidemiological analysis involving only spirometrically confirmed air-flow obstruction as the outcome. The authors combined this with minimal requirements for exposure characterization allowing for analysis of population-based studies. Affiliation 19Review Scand J Work Environ Health. 2014;40(1):19-35. doi:10.5271/sjweh.3400 Occupational chronic obstructive pulmonary disease: a systematic literature review Objective Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures.Methods We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively. ResultsThere was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD. ConclusionThere is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.Key terms: airflow obstruction; COPD; dust; fume; gas; lung function measurement; occupational exposure; vapor. Chronic obstructive pulmonary disease (COPD) represents serious morbidity and has emerged as a leading cause of death worldwide (1). Although tobacco smoking is the leading factor in the etiology of COPD, the disease may be caused by inhalation of different gases and aerosols among bot...

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“…For the same reason, diagnosis of COPD was accepted without this index being below 70% in young people. 18 A history of smoking was supportive but not obligatory for COPD. As an illustration, a 52-year-old woman with recurrent cough and dyspnoea who had smoked 25 packyears, with a post-bronchodilator FEV1/FVC ratio of 0.71 and an FEV1 of 80% of predicted value, was diagnosed with COPD because DLCO was lowered (70% of predicted value) and the residual volume was increased (160% of predicted value), which both supported this diagnosis.…”

Section: Panel Diagnosis (Diagnostic Outcome)mentioning

confidence: 95%

Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough

Broekhuizen

Sachs²,

Hoes³

et al. 2010

Br J Gen Pract

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BackgroundChronic obstructive pulmonary disease (COPD) and asthma are underdiagnosed in primary care. AimTo determine how often COPD or asthma are present in middle-aged and older patients who consult their GP for persistent cough. Design of studyA cross-sectional study in 353 patients older than 50 years, visiting their GP for persistent cough and not known to have COPD or asthma. SettingGeneral practice in the Netherlands. MethodAll participants underwent extensive diagnostic workup, including symptoms, signs, spirometry, and body plethysmography. All results were studied by an expert panel to diagnose or exclude COPD and/or asthma. The reproducibility of the panel diagnosis was assessed by calculation of Cohen's κ statistic in a sample of 41 participants. ResultsOf the 353 participants, 102 (29%, 95% confidence interval [CI] = 24 to 34%) were diagnosed with COPD. In 14 of these 102 participants, both COPD and asthma were diagnosed (4%, 95% CI = 2 to 7%). Asthma (without COPD) was diagnosed in 23 (7%, 95% CI = 4 to 10%) participants. Mean duration of cough was 93 days (median 40 days). The reproducibility of the expert panel was good (Cohen's κ = 0.90). ConclusionIn patients aged over 50 years who consult their GP for persistent cough, undetected COPD or asthma is frequently present.

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FEV 1 /FVC Ratio of 70% Misclassifies Patients With Obstruction at the Extremes of Age

Cited by 112 publications

References 10 publications

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Occupational chronic obstructive pulmonary disease: a systematic literature review

Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough

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