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

Bernet Kato, Amund Gulsvik, William Vollmer, Christer Janson, Michael Studnika, A (Sonia) Buist, Peter Burney

Research output: Contribution to journal › Article

2 Citations (Scopus)

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.

Original languageEnglish (US)
Article number102
JournalRespiratory Research
Volume13
DOIs
StatePublished - Nov 16 2012

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Bronchodilator Agents
Spirometry
Sensitivity and Specificity
Obstructive Lung Diseases
Chronic Obstructive Pulmonary Disease
Population
Reference Values
Lung

Keywords

  • BOLD study
  • European population
  • Normal values

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Can spirometric norms be set using pre- or post- bronchodilator test results in older people? / Kato, Bernet; Gulsvik, Amund; Vollmer, William; Janson, Christer; Studnika, Michael; Buist, A (Sonia); Burney, Peter.

In: Respiratory Research, Vol. 13, 102, 16.11.2012.

Research output: Contribution to journal › Article

Kato, B, Gulsvik, A, Vollmer, W, Janson, C, Studnika, M, Buist, AS & Burney, P 2012, 'Can spirometric norms be set using pre- or post- bronchodilator test results in older people?', Respiratory Research, vol. 13, 102. https://doi.org/10.1186/1465-9921-13-102
Kato B, Gulsvik A, Vollmer W, Janson C, Studnika M, Buist AS et al. Can spirometric norms be set using pre- or post- bronchodilator test results in older people? Respiratory Research. 2012 Nov 16;13. 102. https://doi.org/10.1186/1465-9921-13-102
Kato, Bernet ; Gulsvik, Amund ; Vollmer, William ; Janson, Christer ; Studnika, Michael ; Buist, A (Sonia) ; Burney, Peter. / Can spirometric norms be set using pre- or post- bronchodilator test results in older people?. In: Respiratory Research. 2012 ; Vol. 13.
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AU - Buist, A (Sonia)

AU - Burney, Peter

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N2 - 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.

AB - 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.

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