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Optimal spirometry thresholds for the prediction of chronic airflow obstruction: a multinational longitudinal study
Abby H S Lam1,2, Sheikhah A Alhajri1,3,2, James Potts1
1National Heart and Lung Institute, Imperial College London, London, UK.
ERJ Open Research
|March 5, 2025
Summary
Early detection of chronic airflow obstruction is crucial for COPD. Spirometry, specifically the pre-bronchodilator FEV1/FVC ratio below the 9th/10th percentile, effectively identifies individuals at risk, even before symptoms appear.
Area of Science:
- Pulmonary Medicine
- Respiratory Health
- Epidemiology
Background:
- Chronic airflow obstruction is a hallmark of Chronic Obstructive Pulmonary Disease (COPD).
- Current strategies for early detection of chronic airflow obstruction are limited.
- Identifying individuals with early-stage airflow obstruction is critical for timely intervention.
Purpose of the Study:
- To determine optimal z-score thresholds for spirometry parameters to identify chronic airflow obstruction.
- To evaluate the efficacy of spirometry versus respiratory symptoms in predicting airflow obstruction incidence.
- To investigate the influence of smoking status on the risk of developing chronic airflow obstruction.
Main Methods:
- Analysis of data from the multinational Burden of Obstructive Lung Disease (BOLD) study.
- Collection of respiratory symptoms and pre- and post-bronchodilator spirometry at baseline and follow-up (median 8.4 years).
- Calculation of z-scores using NHANES reference equations and identification of optimal thresholds using the Youden index.
Main Results:
- Spirometry parameters demonstrated good discrimination for chronic airflow obstruction incidence (AUC 0.80-0.84), outperforming respiratory symptoms.
- The optimal z-score threshold for pre-bronchodilator FEV1/FVC was identified as <-1.336 (9th percentile), with 78% sensitivity and 72% specificity.
- Lower post-bronchodilator FEV1/FVC and thresholds associated with increased odds of chronic airflow obstruction at follow-up were observed.
Conclusions:
- Spirometry is a more effective tool than respiratory symptoms for predicting the incidence of chronic airflow obstruction.
- A pre-bronchodilator FEV1/FVC ratio below the 9th/10th percentile may indicate early airflow obstruction or pre-COPD.
- Current smokers and, to some extent, never-smokers with low baseline FEV1/FVC ratios, particularly males, face a slightly greater risk.
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