Using the FEV1/FVC < 0.7 as Criterion for Obstruction in the Geriatric Population: Is There a Risk of Overdiagnosis?

Area of Science:

• Pulmonary Medicine
• Geriatric Medicine
• Diagnostic Accuracy

Background:

• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses a fixed forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio < 0.7 for diagnosing airflow obstruction.
• This fixed ratio may lead to overdiagnosis in older adults as FEV1/FVC naturally declines with age.
• The lower limit of normal (LLN) has been proposed as an alternative threshold.

Purpose of the Study:

• To quantify the rate of overdiagnosis using GOLD criteria versus LLN in individuals aged 60 and older.
• To identify an optimal FEV1/FVC threshold minimizing both overdiagnosis and underdiagnosis in this demographic.

Main Methods:

• Retrospective analysis of pulmonary function test (PFT) data from 430 patients aged 60+.
• Patients with FEV1/FVC < 0.7 between 2014 and 2019 were included.
• Comparison of GOLD criteria (FEV1/FVC < 0.7) against LLN and various thresholds for obstruction.

Main Results:

• Overdiagnosis occurred in 35.6% of patients when using the GOLD criteria compared to LLN.
• Utilizing an FEV1/FVC threshold of < 0.65 reduced overdiagnosis to 6.4%.
• An FEV1/FVC ratio of 0.638 represented the optimal threshold with the lowest rates of over- and underdiagnosis.

Conclusions:

• The current GOLD criteria for airflow obstruction may result in significant overdiagnosis (>35%) in patients over 60.
• Adjusting the FEV1/FVC threshold to < 0.65 could enhance diagnostic precision in the geriatric population.
• Further research may validate a revised threshold for improved airflow obstruction diagnosis in older adults.