Restrictive spirometry versus restrictive lung function using the GLI reference values

Abstract

Background: Restrictive lung function may indicate various underlying diseases. The aim of this study was to evaluate the accuracy of different restrictive spirometry patterns (RSPs) to identify restrictive lung function (total lung capacity [TLC] < lower limit of normal [LLN]) according to reference values by the Global Lung Function Initiative (GLI) in a wide age-ranged, general population sample. Methods: A general population sample (n = 607, age 23-72 years, smokers 18.8%) with proper dynamic spirometry and TLC measurements, was included. Accuracy of two main categories of RSP to identify TLC < LLN were evaluated: traditional RSPs (definition 1: FVC < 80% of predicted and FEV 1 /FVC ≥ 0.7 and definition 2: FVC < LLN and FEV 1 /FVC ≥ LLN) and RSPs defined by Youden's method (definition 3: FVC < 85.5% of predicted and FEV 1 /FVC ≥ LLN and definition 4: FVC Z-score < −1.0 and FEV 1 /FVC ≥ LLN).Results: The prevalence of restrictive lung function (TLC < LLN) was 5.3%. The most accurate cut-offs for FVC to identify TLC < LLN were 85.5% for FVC% of predicted, and −1.0 for FVC Z-score. The traditional RSP definitions 1 and 2 had higher specificity (95.0% and 96.9%) but substantially lower sensitivity compared to RSP definitions 3 and 4. Conclusion:Based on the GLI reference values, the RSP definition FVC < LLN and FEV 1 /FVC ≥ LLN yielded the highest specificity and may appropriately be used to rule out restrictive lung function. The RSP definition with the most favourable tradeoff between sensitivity and specificity, FVC < 85.5% of predicted and FEV 1 /FVC ≥ LLN, may serve as an alternative with higher sensitivity for screening.

Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies

“… 8 , 9 We applied the definition derived by Voraphani et al. 8 In our study, the mean predicted FVC in restrictive phenotypes ranged from 66.3% to 78.7%, consistently lower than 85.5% (the cut-off reported as the most favourable trade-off between sensitivity and specificity for diagnosing lung function restriction 25 ). We observed the overall prevalence of obstructive phenotypes of ∼10%, and that of restrictive ∼9% at all ages, which is consistent with previous findings.…”

Physiology and Biomarkers for Surveillance of Occupational Lung Disease

“…Over the years, various algorithms have been proposed to enable use of spirometry data alone to identify individuals who truly require further lung function testing in the occupational arena 45 46 47 and better use of GLI predicative equations may assist. 48 For example, De Matteis et al developed a model using data from 376 hospital patients aged <65 years and compared spirometry with lung volumes measured in a body plethysmograph. The best algorithm achieved high specificity (96%) and PPV.…”

“…Over the years, various algorithms have been proposed to enable use of spirometry data alone to identify individuals who truly require further lung function testing in the occupational arena [45][46][47] and better use of GLI predicative equations may assist. 48 plethysmograph. The best algorithm achieved high specificity (96%) and PPV.…”

Restrictive spirometry pattern among construction trade workers

“…Additionally, slow VC determinations are not normally made during routine spirometry; therefore, forced VC (FVC) is typically substituted for VC in the ratio estimate (FEV 1 /FVC) to define spirometric restriction 2 . Spirometric restriction has been defined in various ways in the literature based on FEV 1 , FVC, and FEV 1 /FVC measurements 3–7 . A commonly used epidemiological definition of restriction is a FVC below LLN in the presence of a normal FEV 1 /FVC.…”

“…2 Spirometric restriction has been defined in various ways in the literature based on FEV 1 , FVC, and FEV 1 /FVC measurements. [3][4][5][6][7] A commonly used epidemiological definition of restriction is a FVC below LLN in the presence of a normal FEV 1 /FVC. Restrictive spirometry pattern (RSP) has become the term of art to describe this condition.…”