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Consequences of using post- or prebronchodilator reference values in interpreting spirometry
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-0553-8067
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2023 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 4, p. 461-471Article in journal (Refereed) Published
Abstract [en]

Rationale: Postbronchodilator spirometry is used for the diagnosis of chronic obstructive pulmonary disease. However, prebronchodilator reference values are used for spirometry interpretation.

Objectives: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using preor postbronchodilator reference values generated within SCAPIS (Swedish CArdioPulmonary bioImage Study) when interpreting postbronchodilator spirometry in a general population.

Methods: SCAPIS reference values for postbronchodilator and prebronchodilator spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or postbronchodilator reference values, with respiratory burden in the SCAPIS general population (28,851 individuals).

Measurements and Main Results: Bronchodilation resulted in higher predicted medians and lower limits of normal (LLNs) for FEV1/FVC ratios. The prevalence of postbronchodilator FEV1/FVC ratio lower than the prebronchodilator LLN was 4.8%, and that of postbronchodilator FEV1/FVC lower than the postbronchodilator LLN was 9.9%, for the general population. An additional 5.1% were identified as having an abnormal postbronchodilator FEV1/FVC ratio, and this group hadmore respiratory symptoms, emphysema (13.5% vs. 4.1%; P < 0.001), and self-reported physician-diagnosed chronic obstructive pulmonary disease (2.8% vs. 0.5%, P < 0.001) than subjects with a postbronchodilator FEV1/FVC ratio greater than the LLN for both pre- and postbronchodilation.

Conclusions: Pre- and postbronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of postbronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using postbronchodilator reference values when interpreting postbronchodilator spirometry might enable the identification of individuals with mild disease and be clinically relevant.

Place, publisher, year, edition, pages
American Thoracic Society , 2023. Vol. 208, no 4, p. 461-471
Keywords [en]
spirometry, pre-bronchodilator, post-bronchodilator, reference values, respiratory burden
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-217871DOI: 10.1164/rccm.202212-2341OCISI: 001055487600023PubMedID: 37339507OAI: oai:DiVA.org:umu-217871DiVA, id: diva2:1819133
Funder
Swedish Heart Lung FoundationKnut and Alice Wallenberg FoundationSwedish Research CouncilVinnovaUniversity of GothenburgKarolinska InstituteLinköpings universitetLund UniversityUmeå UniversityUppsala UniversitySwedish Association of Local Authorities and RegionsAvailable from: 2023-12-13 Created: 2023-12-13 Last updated: 2023-12-13Bibliographically approved

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Backman, HelenaBlomberg, AndersEriksson Ström, JonasLindberg, Anne

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Backman, HelenaBlomberg, AndersCaidahl, KennethEriksson Ström, JonasLindberg, AnneEngvall, Jan E.
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