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Which spirometric indices best predict subsequent death from chronic obstructive pulmonary disease?
1Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE, UK.
Thorax
|August 19, 2000
Summary
Mid-expiratory flow rates, alongside forced expiratory volume in 1 second (FEV(1)), strongly predict chronic obstructive pulmonary disease (COPD) mortality. End-expiratory flow rates offer minimal additional predictive value for fatal COPD outcomes.
Area of Science:
- Pulmonary Medicine
- Epidemiology
- Respiratory Physiology
Background:
- Previous studies linked forced expiratory volumes (FEV) to COPD mortality.
- The predictive power of other spirometric indices for COPD mortality remained unclear.
Purpose of the Study:
- To investigate whether spirometric indices beyond FEV(1) could better predict fatal COPD.
- To compare the predictive value of different expiratory flow rates for COPD mortality.
Main Methods:
- A case-control study involving 143 fatal COPD cases and 143 matched controls from London civil servants followed for 20 years.
- Spirograms were analyzed, comparing various flow rates (FEV(1), mid-expiratory, end-expiratory) between cases and controls.
- Conditional logistic regression analyzed flow rates as predictors of fatal COPD.
Main Results:
- Mid-expiratory flow rates (FEF(50-75), FEF(75-85)) were strong predictors of COPD mortality, independently of FEV(1).
- End-expiratory flow rates (FEF(85-95)) showed weaker correlations and did not independently predict fatal COPD.
- A 10% decrement in FEF(50-75) was associated with a 2.24-fold increased mortality risk for fatal COPD.
Conclusions:
- Confirms FEV(1) and mid-expiratory flow rates as significant predictors of COPD mortality.
- Suggests that measuring end-expiratory flow rates provides limited additional prognostic information for COPD.