Debating the definition of airflow obstruction: time to move on?

Miller, Martin; Pedersen, Ole F.; Pellegrino, Riccardo; Brusasco, Vito

doi:10.1183/09031936.00103309

Cited by 32 publications

(20 citation statements)

References 10 publications

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“…Moreover, our findings indicate that using the GOLD criteria overestimates airway obstruction in the oldest subjects and underestimates airway obstruction in the youngest subjects with respect to the ATS/ERS recommended criteria, as reported by other authors [10,20,35]. In particular, using the GOLD criteria compared with the LLN, airway obstruction was underestimated until the decade 30-39 yrs and overestimated starting with the decade 40-49 yrs ( fig.…”

Section: Discussionsupporting

confidence: 66%

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Maio¹,

Sherrill²,

MacNee³

et al. 2012

Eur Respir J

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In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing tent during the annual ERS Congresses in 2004-2009. Spirometry was performed during the ERS Congresses in volunteers; all participants answered a simple, brief questionnaire on their descriptive characteristics, smoking and asthma. Portable spirometers were freely provided by the manufacturer. Nurses and doctors from pulmonary departments of local hospitals/universities gave their service for free. Lower limit of normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for diagnosing and grading airway obstruction were used.Of 12,448 participants in six congress cities, 10,395 (83.5%) performed acceptable spirometry (mean age 51.0¡18.4 yrs; 25.5% smokers; 5.5% asthmatic). Airway obstruction was present in 12.4% of investigated subjects according to LLN criteria and 20.3% according to GOLD criteria. Through multinomial logistic regression analysis, age, smoking habits and asthma were significant risk factors for airway obstruction. Relative risk ratio and 95% confidence interval for LLN stage I, for example, was 2.9 (2.0-4.1) for the youngest age (f19 yrs), 1.9 (1.2-3.0) for the oldest age (o80 yrs), 2.4 (2.0-2.9) for current smokers and 2.8 (2.2-3.6) for reported asthma diagnosis.In addition to being a useful advocacy tool, the spirometry tent represents an unusual occasion for early detection of airway obstruction in large numbers of city residents with an important public health perspective.

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Section: Discussionsupporting

confidence: 66%

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Maio¹,

Sherrill²,

MacNee³

et al. 2012

Eur Respir J

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“…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). This misclassification, however, would most likely influence the estimate of the proportion of subjects with disease rather than skew the association between disease and exposure.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The Global Initiative on Obstructive Lung Disease (GOLD) has proposed that the criterion forced expiratory volume in one second (FEV 1 )/forced vital capacity (FVC) ratio <70% as an indication of the presence of COPD (5). The staging of the severity of COPD in GOLD is based on the reduction in FEV 1 (as percent predicted) but has obvious limitations in clinical prediction (6). Moreover, variation in diagnostic criteria makes comparison of studies from different time periods and countries problematic.…”

mentioning

confidence: 99%

Occupational chronic obstructive pulmonary disease: a systematic literature review

Omland

Würtz

Aasen³

et al. 2013

Scand J Work Environ Health

121

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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“…Furthermore, adult smokers suspected of having COPD are not at increased risk of respiratory symptoms, respiratory morbidity, or all-cause mortality until the ratio falls below the age-corrected fifth percentile LLN range. 21 Using the LLN values for FEV1/FVC that are based on the normal distribution and classifying the bottom 5% of the healthy population as abnormal has therefore been suggested as an alternative way to minimise potential misclassification. 22 The absence of any significant difference between diagnostic groups in reversibility to bronchodilator was surprising.…”

Section: Main Findingsmentioning

confidence: 99%

Accuracy of asthma and COPD diagnosis in Australian general practice: a mixed methods study

Abramson

Schattner

Sulaiman

et al. 2012

Primary Care Respiratory Journal

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Debating the definition of airflow obstruction: time to move on?

Cited by 32 publications

References 10 publications

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Occupational chronic obstructive pulmonary disease: a systematic literature review

Accuracy of asthma and COPD diagnosis in Australian general practice: a mixed methods study

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