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Impacts of Different Spirometry Reference Equations and Diagnostic Criteria on the Frequency of Airway Obstruction in Adult People of North China

Authors Xie M, Cui L, Liu J, Wang W, Li J, Xiao W

Received 29 September 2019

Accepted for publication 13 March 2020

Published 27 March 2020 Volume 2020:15 Pages 651—659


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Chunxue Bai

Mengshuang Xie, Liwei Cui, Jinhuan Liu, Wei Wang, Jun Li, Wei Xiao

Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China

Correspondence: Wei Xiao
Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua West Road, Jinan 250012, People’s Republic of China
Tel/ Fax +86 53182166294

Background and Objective: The reference equations and diagnostic criteria play a critical role in the interpretation of pulmonary function tests (PFTs). The aim was to investigate the impacts of different reference equations and diagnostic criteria on the frequency of airway obstruction in adult people of a large teaching hospital of North China.
Methods: The spirometry data of all adult people who underwent PFTs in Qilu hospital from April 2012 to November 2015 were collected. Two spirometry reference equations, namely, Zhongshan-2011 and Global Lung Function Initiative 2012 (GLI-2012) were compared. The frequency of airway obstruction using different spirometry prediction equations and diagnostic criteria including forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 92% of predicted value and FEV1/FVC <lower limits of normal (LLN) were investigated.
Results: A total of 57,888 subjects were recruited with a mean age of 55.5 ±  13.72. There were significant differences in LLN and predicted value between the GLI-2012 and Zhongshan-2011. The average age of those who had an LLN of FEV1/FVC below 0.7 was 66.59 ±  6.05 years using GLI-2012, which was significantly lower than that in Zhongshan-2011 (77.46± 2.63, P< 0.001). Using FEV1/FVC<LLN as diagnostic criteria, Zhongshan-2011 identifies more obstructive subjects than GLI-2012 in each age group. In 45–59 or 60–80 age group, more participants were defined as obstructive using FEV1/FVC<92%pred than FEV1/FVC<LLN (both P<0.001).
Conclusion: Zhongshan-2011 identifies more airway obstruction than GLI-2012 in adult people of North China. Compared to FEV1/FVC<LLN, FEV1/FVC< 92%pred may lead to overdiagnosis of airway obstruction in elderly people.

Keywords: lung function, LLN, airflow limitation, reference equations, COPD

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