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Comparative Study
. 2012 Nov 16;13(1):102.
doi: 10.1186/1465-9921-13-102.

Can spirometric norms be set using pre- or post- bronchodilator test results in older people?

Bernet Kato  1 , Amund Gulsvik, William Vollmer, Christer Janson, Michael Studnika, Sonia Buist, Peter Burney
Affiliations
Comparative Study

Can spirometric norms be set using pre- or post- bronchodilator test results in older people?

Bernet Kato et al. Respir Res. .

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined by post-bronchodilator spirometry. Data on "normal values" come predominantly from pre-bronchodilator spirometry. The effects of this on diagnosis are unknown.

Methods: Lower limits of normal (LLN) were estimated from "normal" participants in the Burden of Obstructive Lung Disease (BOLD) programme. Values separately derived using pre- and post-bronchodilator spirometry were compared. Sensitivity and specificity of criteria derived from pre-bronchodilator spirometry and pre-bronchodilator spirometry adjusted by a constant were assessed in the remaining population. The "gold standard" was the LLN for the post-bronchodilator spirometry in the "normal population". For FEV1/FVC, sensitivity and specificity of criteria were also assessed when a fixed value of < 70% was used rather than LLN.

Results: Of 6,600 participants with full data, 1,354 were defined as "normal". Mean differences between pre- and post- bronchodilator measurements were small and the Bland-Altman plots showed no association between difference and mean value. Compared with using the gold standard, however, tests using pre-bronchodilator spirometry had a sensitivity and specificity of detecting a low FEV1 of 78.4% and 100%, a low FVC of 99.8% and 99.1% and a low FEV1/FVC ratio of 65% and 100%. Adjusting this by a constant improved the sensitivity without substantially altering the specificity for FEV1 (99%, 99.8%), FVC (97.4%, 99.9%) and FEV1/FVC (98.7%, 99.5%).

Conclusions: Using pre-bronchodilator spirometry to derive norms for lung function reduces sensitivity compared to a post-bronchodilator gold standard. Adjustment of these values by a constant can improve validity of the test.

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Figures

Figure 1
Figure 1
Bland Altman plots for observed FEV1, FEV6, FVC and FEV1/FVC (males – solid circles, females – hollow circles). The lines show the mean difference between pre- and post bronchodilator measured lung function for males (solid line) and females (dotted line).
Figure 2
Figure 2
Bland Altman plots for LLN values of FEV1, FEV6, FVC and FEV1/FVC (males – solid circles, females – hollow circles). The lines show the mean difference between pre- and post bronchodilator LLN values for males (solid line) and females (dotted line).
Figure 3
Figure 3
Plots of residuals versus predicted values for pre-bronchodilator lung function.
Figure 4
Figure 4
Plots of residuals versus predicted values for post-bronchodilator lung function.
See this image and copyright information in PMC

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