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Related Experiment Videos

Discriminating measures and normal values for expiratory obstruction.

James E Hansen1, Xing-Guo Sun1, Karlman Wasserman1

  • 1Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Harbor-UCLA Medical Center, Los Angeles Biomedical Institute at Harbor UCLA Medical Center, Torrance, CA.

Chest
|February 16, 2006
PubMed
Summary

New spirometry measures, forced expiratory volume in 3 s (FEV3)/FVC and 1 - FEV3/FVC, effectively identify smoking-related airflow limitation. Forced expiratory flow, midexpiratory phase (FEF(25-75)) can be misleading in smokers.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Airflow limitation is a key indicator of respiratory disease.
  • Existing spirometry measures like FEV1/FVC and FEF(25-75) have limitations in accurately assessing obstruction, especially in diverse populations and smokers.
  • The forced expiratory volume in 3 s (FEV3)/FVC ratio and derived measures offer potential for improved assessment.

Purpose of the Study:

  • To establish reference values for FEV3/FVC in different adult ethnic groups.
  • To compare the variability of FEV1/FVC, FEV3/FVC, and FEF(25-75) in non-smokers.
  • To evaluate the utility of these measures in detecting smoking-induced airflow limitation and to introduce 1 - FEV3/FVC for identifying lung units with long time constants.

Main Methods:

  • Analysis of spirometry data from the Third National Health and Nutrition Examination Survey (NHANES III).

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  • Inclusion of 5,938 adult never-smokers and 3,570 current smokers meeting ATS standards.
  • Development of new databases for never-smokers and current smokers to quantify spirometric parameters.

    • Main Results:

    • FEV3/FVC values and their lower limits of normal were determined for never-smokers.
    • Current smokers showed accelerated decline in FEV3/FVC and increased 1 - FEV3/FVC with age compared to never-smokers, equivalent to approximately 20 years of accelerated aging.
    • FEF(25-75) demonstrated high rates of false positives in never-smokers and false negatives in smokers with reduced FEV1/FVC and/or FEV3/FVC.

    Conclusions:

    • FEV1/FVC, FEV3/FVC, and 1 - FEV3/FVC are reliable indicators of expiratory obstruction.
    • FEF(25-75) can be misleading, leading to a significant number of inaccurate diagnoses (false positives and false negatives).
    • The FEV3/FVC ratio and its derivatives provide a more robust assessment of airflow limitation, particularly in the context of smoking.