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 journalArticle

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

Fingerprint

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 journalArticle

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.
@article{b1b85e92b3f74e189ecb51ed4f831608,
title = "Can spirometric norms be set using pre- or post- bronchodilator test results in older people?",
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.",
keywords = "BOLD study, European population, Normal values",
author = "Bernet Kato and Amund Gulsvik and William Vollmer and Christer Janson and Michael Studnika and Buist, {A (Sonia)} and Peter Burney",
year = "2012",
month = "11",
day = "16",
doi = "10.1186/1465-9921-13-102",
language = "English (US)",
volume = "13",
journal = "Respiratory Research",
issn = "1465-9921",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Can spirometric norms be set using pre- or post- bronchodilator test results in older people?

AU - Kato, Bernet

AU - Gulsvik, Amund

AU - Vollmer, William

AU - Janson, Christer

AU - Studnika, Michael

AU - Buist, A (Sonia)

AU - Burney, Peter

PY - 2012/11/16

Y1 - 2012/11/16

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.

KW - BOLD study

KW - European population

KW - Normal values

UR - http://www.scopus.com/inward/record.url?scp=84869034597&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869034597&partnerID=8YFLogxK

U2 - 10.1186/1465-9921-13-102

DO - 10.1186/1465-9921-13-102

M3 - Article

VL - 13

JO - Respiratory Research

JF - Respiratory Research

SN - 1465-9921

M1 - 102

ER -