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FEF25-75% Values in Patients with Normal Lung Function Can Predict the Development of Chronic Obstructive Pulmonary Disease

Authors Kwon DS, Choi YJ, Kim TH, Byun MK, Cho JH, Kim HJ, Park HJ

Received 21 July 2020

Accepted for publication 26 October 2020

Published 12 November 2020 Volume 2020:15 Pages 2913—2921


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell

Do Sun Kwon,1,* Yong Jun Choi,2,* Tae Hee Kim,2 Min Kwang Byun,2 Jae Hwa Cho,2 Hyung Jung Kim,2 Hye Jung Park2

1Department of Internal Medicine, Hallym Hospital, Incheon, Korea; 2Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

*These authors contributed equally to this work

Correspondence: Hye Jung Park Department of Internal Medicine
Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 60273, Republic of Korea
Tel +82-2-2019-3302
Fax +82-2-3463-3882

Purpose: The forced mid-expiratory flow (FEF25-75%) value is a potentially sensitive marker of obstructive peripheral airflow. We aimed to assess whether FEF25-75% can be an early predictor of chronic obstructive pulmonary disease (COPD).
Patients and Methods: Between July 1, 2007 and June 31, 2009, we identified 3624 patients who underwent a pulmonary function test (PFT) in Gangnam Severance Hospital. We selected 307 patients aged over 40 years without COPD who had normal PFT results at baseline and who had follow-up PFT records more than 1 year later. A FEF25-75% z-score less than − 0.8435 was considered low. We defined COPD as a forced expiratory volume in one second/forced vital capacity value of less than 0.7 before July 31, 2019.
Results: Among 307 patients, 91 (29.6%) had low FEF25-75% at baseline. After 10 years, the incidence rate of COPD in the low FEF25-75% group was significantly higher than that in the normal FEF25-75% group (41.8% vs 7.4%; P-value< 0.001). The Cox proportional hazard model showed that age (hazard ratio [HR]  1.09; P-value< 0.001), smoking status (occasional smoker HR, 4.59; P-value< 0.001 and long-term smoker HR, 2.18; P-value=0.023), and low FEF25-75% (HR, 3.31; P-value< 0.001) were predictive factors for the development of COPD.
Conclusion: The FEF25-75% value in patients with normal lung function is a useful predictor for the development of COPD. We should carefully monitor patients who present with low FEF25-75% values, even if they have normal lung function.

Keywords: COPD, respiratory function tests, tobacco

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