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Patterns of spirogram abnormality in individual smokers.

M R Miller, A C Pincock, D M Grove

    The American Review of Respiratory Disease
    |November 1, 1985
    PubMed
    Summary
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    Certain spirometric indices effectively identify smokers with abnormal lung function, revealing two distinct patterns of ventilatory impairment. These findings support the Dutch hypothesis over the small airways hypothesis for chronic airflow limitation in smokers.

    Area of Science:

    • Pulmonary Medicine
    • Respiratory Physiology

    Background:

    • Smoking is a major cause of chronic obstructive pulmonary disease (COPD).
    • Understanding the patterns of ventilatory dysfunction in smokers is crucial for early diagnosis and intervention.
    • Existing hypotheses, such as the small airways hypothesis and the Dutch hypothesis, attempt to explain the development of airflow limitation in smokers.

    Purpose of the Study:

    • To assess dynamic ventilatory function in a cohort of male and female smokers.
    • To compare smokers' lung function with predicted values from non-smoker controls.
    • To identify specific spirometric indices and patterns that can effectively detect abnormalities in individual smokers.

    Main Methods:

    • Dynamic ventilatory function was measured in 147 males and 212 females.

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  • Results were compared to predicted values from non-smokers, with deviations expressed as standardized residuals (SR).
  • Analysis focused on flow indices (FMF, FEF50, FEF75) and volume-standardized indices (FEV1/FVC%, FEV3/FVC%, alpha(1) 75%, MR90%, mu).

    • Main Results:

    • Flow indices showed group changes but were less effective in identifying individual smokers with abnormalities.
    • Volume-standardized indices, including FEV1/FVC% and time domain indices, effectively identified subjects with marked abnormalities.
    • Two patterns of spirometric abnormality were identified: Pattern 1 (early FVC changes) affected 15% of females and 14% of males; Pattern 2 (late FVC changes) affected 4% of both sexes.

    Conclusions:

    • Volume-standardized spirometric indices are superior to flow indices for identifying smokers with significant ventilatory abnormalities.
    • The identified patterns of abnormality in smokers are more consistent with the "Dutch hypothesis" than the "small airways hypothesis" regarding the development of chronic airflow limitation.