Can spirometric norms be set using pre- or post- bronchodilator test results in older people?

Title: Can spirometric norms be set using pre- or post- bronchodilator test results in older people?
Author(s): Kato, B
Gulsvik, A
Vollmer, W
Janson, C
Studnika, M
Buist, S
Burney, P
Item Type: Journal Article
Abstract: ABSTRACT: BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is defined by post-bronchodilator spirometry. Data on "normal values" come predominantly from pre-bronchodilator spirometry. The effects of this on diagnosis are unknown. METHODS: Lower limits of normal (LLN) were estimated from "normal" participants in the Burden of Obstructive Lung Disease (BOLD) programme. Values separately derived using pre- and post-bronchodilator spirometry were compared. Sensitivity and specificity of criteria derived from pre-bronchodilator spirometry and pre-bronchodilator spirometry adjusted by a constant were assessed in the remaining population. The "gold standard" was the LLN for the post-bronchodilator spirometry in the "normal population". For FEV1/FVC, sensitivity and specificity of criteria were also assessed when a fixed value of < 70% was used rather than LLN. RESULTS: Of 6,600 participants with full data, 1,354 were defined as "normal". Mean differences between pre- and post- bronchodilator measurements were small and the Bland-Altman plots showed no association between difference and mean value. Compared with using the gold standard, however, tests using pre-bronchodilator spirometry had a sensitivity and specificity of detecting a low FEV1 of 78.4% and 100%, a low FVC of 99.8% and 99.1% and a low FEV1/FVC ratio of 65% and 100%. Adjusting this by a constant improved the sensitivity without substantially altering the specificity for FEV1 (99%, 99.8%), FVC (97.4%, 99.9%) and FEV1/FVC (98.7%, 99.5%). CONCLUSIONS: Using pre-bronchodilator spirometry to derive norms for lung function reduces sensitivity compared to a post-bronchodilator gold standard. Adjustment of these values by a constant can improve validity of the test.
Publication Date: 16-Nov-2012
Date of Acceptance: 31-Oct-2012
URI: http://hdl.handle.net/10044/1/53650
DOI: https://dx.doi.org/10.1186/1465-9921-13-102
ISSN: 1465-9921
Publisher: BioMed Central
Start Page: 102
End Page: 9921-13-102
Journal / Book Title: Respiratory Research
Volume: 13
Copyright Statement: © 2012 Kato et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Funder's Grant Number: G0801056B
G0901214
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
RESPIRATORY SYSTEM
Normal values
BOLD study
European population
REFERENCE VALUES
DISEASE
Age Factors
Aged
Bronchodilator Agents
Europe
Forced Expiratory Volume
Humans
Lung
Middle Aged
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive
Reference Values
Reproducibility of Results
Sensitivity and Specificity
Spirometry
Vital Capacity
Lung
Humans
Pulmonary Disease, Chronic Obstructive
Bronchodilator Agents
Vital Capacity
Forced Expiratory Volume
Spirometry
Sensitivity and Specificity
Reproducibility of Results
Predictive Value of Tests
Age Factors
Reference Values
Aged
Middle Aged
Europe
1102 Cardiovascular Medicine And Haematology
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Appears in Collections:Population Genetics and Gene Therapy
Infectious Disease Epidemiology
National Heart and Lung Institute
Faculty of Medicine



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