Population impact of different definitions of airway obstruction

There is currently no consensus on the criteria for diagnosing chronic obstructive pulmonary disease. This study evaluated the impact of different definitions of airway obstruction on the estimated prevalence of obstruction in a population-based sample. Using the Third National Health and Nutrition Examination Survey, obstructive airway disease was defined using the following criteria: 1) self-reported diagnosis of chronic bronchitis or emphysema; 2) forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.70 and FEV1 <80% predicted (Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage IIA); 3) FEV1/FVC below the lower limit of normal; 4) FEV1/FVC <88% pred in males and <89% pred in females; 5) FEV1/FVC <0.70 (“fixed ratio”). Spirometry in this dataset did not include reversibility testing, making it impossible to distinguish reversible from irreversible obstruction. Rates in adults varied from 77 per 1,000 (self-report) to 168 per 1,000 (fixed ratio). For persons aged >50 yrs, the fixed ratio criteria produced the highest rate estimates. For all subgroups tested, the GOLD Stage II criteria produced lower estimates than other spirometry-based definitions. Different definitions of obstruction may produce prevalence estimates that vary by >200%. International opinion leaders should agree upon a clear definition of chronic obstructive pulmonary disease that can serve as a population-based measurement criterion as well as a guide to clinicians.

[1]  A. Iqbal,et al.  Interpreting COPD prevalence estimates: what is the true burden of disease? , 2003, Chest.

[2]  A. Iqbal,et al.  Worldwide guidelines for chronic obstructive pulmonary disease: A comparison of diagnosis and treatment recommendations , 2002, Respirology.

[3]  D. Mannino,et al.  Chronic obstructive pulmonary disease surveillance--United States, 1971-2000. , 2002, Morbidity and mortality weekly report. Surveillance summaries.

[4]  W. Bailey,et al.  Editorial: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines for COPD, Including COVID-19, Climate Change, and Air Pollution , 2023, Medical science monitor : international medical journal of experimental and clinical research.

[5]  D. Mannino.  COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity. , 2002, Chest.

[6]  P. Barnes,et al.  Chronic obstructive pulmonary disease. , 2000, The New England journal of medicine.

[7]  B Neal,et al.  Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials , 2000, The Lancet.

[8]  T L Petty,et al.  Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. , 2000, Archives of internal medicine.

[9]  P. Calverley,et al.  COPD: early detection and intervention. , 2000, Chest.

[10]  G. Viegi,et al.  Prevalence of airways obstruction in a general population: European Respiratory Society vs American Thoracic Society definition. , 2000, Chest.

[11]  N. Voelkel.  Raising awareness of COPD in primary care. , 2000, Chest.

[12]  S. Hurd.  International efforts directed at attacking the problem of COPD. , 2000, Chest.

[13]  M. Bottai,et al.  Smooth reference equations for slow vital capacity and flow-volume curve indexes. , 2000, American journal of respiratory and critical care medicine.

[14]  G. Catalano,et al.  Serum interleukin-10 levels as a prognostic factor in advanced non-small cell lung cancer patients. , 2000, Chest.

[15]  N. Soehendra,et al.  Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer. , 2000, Chest.

[16]  A. Gulsvik,et al.  Comparison of respiratory symptoms questionnaires. , 2000, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[17]  J L Hankinson,et al.  Spirometric reference values from a sample of the general U.S. population. , 1999, American journal of respiratory and critical care medicine.

[18]  S K Chhabra,et al.  Forced vital capacity, slow vital capacity, or inspiratory vital capacity: which is the best measure of vital capacity? , 1998, The Journal of asthma : official journal of the Association for the Care of Asthma.

[19]  R. Pellegrino,et al.  Vital capacities in acute and chronic airway obstruction: dependence on flow and volume histories. , 1997, The European respiratory journal.

[20]  J C Yernault,et al.  Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. , 1995, The European respiratory journal.

[21]  Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Series 1: programs and collection procedures. , 1994, Vital and health statistics. Ser. 1, Programs and collection procedures.

[22]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[23]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[24]  A. Rodgers,et al.  The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. , 1993, Clinical and experimental hypertension.

[25]  A. Miller,et al.  Lung function testing: selection of reference values and interpretative strategies. , 1992, The American review of respiratory disease.

[26]  P. Burge,et al.  Variability and reversibility of the slow and forced vital capacity in chronic airflow obstruction. , 1987, British journal of diseases of the chest.

[27]  Phillips Yy,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. , 1987, The American review of respiratory disease.

[28]  L. Wilkins.  Hypertension prevalence and the status of awareness, treatment, and control in the United States. Final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. , 1985, Hypertension.

[29]  M. Lebowitz,et al.  Changes in the normal maximal expiratory flow-volume curve with growth and aging. , 1983, The American review of respiratory disease.

[30]  R M Gardner,et al.  Reference spirometric values using techniques and equipment that meet ATS recommendations. , 2015, The American review of respiratory disease.