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Post-bronchodilator spirometry reference values in adults and implications for disease management.

Ane Johannessen1, Sverre Lehmann, Ernst R Omenaas

  • 1Institute of Medicine, Department of Public Health and Primary Health Care, University of Bergen, and Department of Thoracic Medicine and Centre for Clinical Research, Haukeland University Hospital, N-5021 Bergen, Norway. Ane.Johannessen@helse-bergen.no

American Journal of Respiratory and Critical Care Medicine
|March 25, 2006
PubMed
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This study developed the first reference values for post-bronchodilator spirometry, crucial for accurately diagnosing and classifying chronic obstructive pulmonary disease (COPD). These new values improve COPD management by preventing underestimation of disease severity.

Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • International guidelines recommend post-bronchodilator spirometry for COPD diagnosis and staging.
  • Current guidelines lack established post-bronchodilator reference values, hindering accurate assessment.

Purpose of the Study:

  • To derive reference values for post-bronchodilator forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC.
  • To compare these new post-bronchodilator values with existing pre-bronchodilator references.

Main Methods:

  • Spirometry with reversibility testing was performed on 2,235 subjects from a general adult population.
  • A reference group of 515 healthy never-smokers was analyzed.
  • Quantile regression modeled reference values for pre- and post-bronchodilator lung function.

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Main Results:

  • Post-bronchodilator FEV1 and FVC decreased with age and increased with height.
  • The lower-limit-of-normal post-bronchodilator FEV1/FVC exceeded 0.7 in both sexes.
  • New post-bronchodilator equations yielded higher predicted FEV1 and FEV1/FVC compared to pre-bronchodilator equations.

Conclusions:

  • This study presents the first reference values for post-bronchodilator lung function.
  • Utilizing post-bronchodilator prediction equations aids in more accurate COPD severity assessment.
  • Improved COPD management is facilitated by avoiding false elevations in FEV1% predicted.