Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence

Bäckman, Helena; Eriksson, Berne; Hedman, Linnéa; Stridsman, Caroline; Jansson, Sven-Arne; Sovijärvi, Anssi; Lindberg, Anne; Rönmark, Eva; Lundbäck, Bo

doi:10.1016/j.rmed.2016.10.005

Cited by 58 publications

(51 citation statements)

References 38 publications

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“…1). The prevalence of restrictive lung function in our patients is higher than values reported in a Swedish general population sample, aged 21-86 years, where the prevalence of a restrictive spirometric pattern was 9-11% when based on pre-bronchodilator values and 7% when based on post-bronchodilator values; however, the role of GFR was not investigated [27]. …”

Section: Discussioncontrasting

confidence: 72%

Lung Dysfunction and Mortality in Patients with Chronic Kidney Disease

Mukai

Pei

Lindholm

et al. 2018

Kidney Blood Press Res

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Background/Aims: Lung dysfunction associates with increased mortality but the impact of chronic kidney disease (CKD) is less clear. We evaluated lung function and its association with mortality among individuals with normal to severely reduced glomerular filtration rate (GFR). Methods: 404 individuals representing GFR category G1 (n=31; GFR >90 mL/min/1.73 m²), G2 (n=46), G3 (n=33), G4 (n=49) and G5 (n=245; GFR< 15 mL/min/1.73 m²) underwent spirometry yielding lung function indices forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁) and peak expiratory flow (PEF). Associations of lung function indices expressed as percentages of predicted values (%FEV₁, %FVC and %PEF) with 5-year mortality were analyzed by competing-risk regression models. Results: The prevalence of obstructive (6% in G1 and 11% in G5) and especially restrictive (9% in G1 to 36% in G5) lung dysfunction increased with declining GFR and with higher comorbidity burden. In patients (n=22) with protein-energy wasting, inflammation and cardiovascular disease, the prevalence of restrictive lung function was 64%. The highest tertiles of % FEV₁ and %FVC associated with lower sub-hazard ratios (sHR) for all-cause mortality, 0.49 (95% CI, 0.27-0.88)) and 0.56 (95% CI, 0.32-0.98), and that of %FEV₁ also with lower cardiovascular mortality risk (sHR 0.16; 95%CI 0.04-0.69) after adjusting for multiple confounders. Restrictive lung dysfunction (FEV₁/FVC ≥ 0.70, and %FVC < 80) associated with increased mortality risk (sHR 1.80, 95%CI, 1.04-3.13) while the association with obstructive lung impairment was not statistically significant. Conclusion: Lung dysfunction and in particular restrictive lung dysfunction associates with degree of renal function impairment and presence of comorbidities, and is an independent predictor of increased mortality in CKD patients.

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Section: Discussioncontrasting

confidence: 72%

Lung Dysfunction and Mortality in Patients with Chronic Kidney Disease

Mukai

Pei

Lindholm

et al. 2018

Kidney Blood Press Res

View full text Add to dashboard Cite

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“…We derived the percent value predicted for FVC and the Lower-Limit of Normal (LLN) for the FEV 1 /FVC ratio using study-specific equations [9,22]. A restrictive spirometry pattern was defined as having a post-bronchodilator FEV 1 /FVC ≥ LLN and a FVC < 80% predicted [7].…”

Section: Lung Function Measurementmentioning

confidence: 99%

“…The strengths of our study include the use of post-bronchodilator lung function measurements to define restrictive spirometry pattern, which are less prone to misclassification compared to pre-bronchodilator measurements [7]. Second, we used two distinct methods for assessing physical activity levels.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Its causes are diverse and include lung fibrosis, systemic inflammation, obesity and psychological health, among others [1,5]. The prevalence of restrictive spirometry pattern in adults is estimated to be between 5 and 10% [6,7], nearly as high as the prevalence of chronic obstructive pulmonary disease (COPD). In contrast to COPD, which is very well known and studied, restrictive spirometry pattern has only recently received any attention and there is no clear recommendation for its management [8].…”

Section: Introductionmentioning

confidence: 99%

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Restrictive spirometry pattern is associated with low physical activity levels. A population based international study

Carsin

Fuertes

Schaffner

et al. 2019

Respiratory Medicine

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Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV 1 /FVC ≥ Lower Limit of Normal and a FVC < 80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (< 1st study-specific tertile) was evaluated using adjusted logistic regression models. Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/ week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding. Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

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“…Some general population studies report using RSP as a proxy for true pulmonary restriction [10][11][12][13][14]. However, the prevalence of true pulmonary restriction in these general population studies is unknown, as TLC was not measured.…”

Section: Introductionmentioning

confidence: 99%

Restrictive spirometric pattern and true pulmonary restriction in a general population sample aged 50 - 64 years

et al. 2020

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Background: There is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction. This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. There is, however, a lack of data from general populations analyzing whether RSP is a valid proxy for true pulmonary restriction. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry. Methods: The data was from the Swedish CArdioPulmonary bioImage Study (SCAPIS Pilot), a general populationbased study, comprising 983 adults aged 50-64. All subjects answered a respiratory questionnaire. Forced expiratory volume in 1 s (FEV 1) and forced vital capacity (FVC) were obtained before and after bronchodilation. TLC and residual volume (RV) was recorded using a body plethysmograph. All lung function values are generally expressed as percent predicted (% predicted) or in relation to lower limits of normal (LLN). True pulmonary restriction was defined as TLC < LLN 5 defined as a Z score < − 1.645, i e the fifth percentile. RSP was defined as FEV 1 /FVC ≥ LLN and FVC < LLN after bronchodilation. Specificity, sensitivity, positive and negative likelihood ratios were calculated, and 95% confidence intervals (CIs) were calculated. Results: The prevalence of true pulmonary restriction was 5.4%, and the prevalence of RSP was 3.4%. The sensitivity of RSP to identify true pulmonary restriction was 0.34 (0.20-0.46), the corresponding specificity was 0.98 (0.97-0.99), and the positive likelihood ratio was 21.1 (11.3-39.4) and the negative likelihood ratio was 0.67 (0.55-0.81). Conclusions: RSP has low accuracy for identifying true pulmonary restriction. The results support previous observations that RSP is useful for ruling out true pulmonary restriction.

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Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence

Cited by 58 publications

References 38 publications

Lung Dysfunction and Mortality in Patients with Chronic Kidney Disease

Lung Dysfunction and Mortality in Patients with Chronic Kidney Disease

Restrictive spirometry pattern is associated with low physical activity levels. A population based international study

Restrictive spirometric pattern and true pulmonary restriction in a general population sample aged 50 - 64 years

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