Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;41(2):181-191.
doi: 10.1111/cpf.12684. Epub 2020 Dec 22.

The ratio FEV1 /FVC and its association to respiratory symptoms-A Swedish general population study

Kjell Torén  1   2 , Linus Schiöler  1 , Anne Lindberg  3 , Anders Andersson  4   5 , Annelie F Behndig  3 , Göran Bergström  6 , Anders Blomberg  3 , Kenneth Caidahl  7 , Jan E Engvall  8   9 , Maria J Eriksson  7   10 , Viktor Hamrefors  11   12 , Christer Janson  13 , David Kylhammar  9 , Eva Lindberg  13 , Anders Lindén  14   15 , Andrei Malinovschi  16 , Hans Lennart Persson  9   17 , Martin Sandelin  18 , Jonas Eriksson Ström  3 , Hanan Tanash  19 , Jenny Vikgren  20 , Carl Johan Östgren  21 , Per Wollmer  22 , C Magnus Sköld  15   23
Affiliations

The ratio FEV1 /FVC and its association to respiratory symptoms-A Swedish general population study

Kjell Torén et al. Clin Physiol Funct Imaging. 2021 Mar.

Abstract

Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1 )/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1 /FVC were associated with any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1 /FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1 /FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1 /FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1 /FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1 /FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1 /FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.

Keywords: COPD; GOLD; SCAPIS; chronic airflow limitation; cough with phlegm; dyspnoea; wheeze.

PubMed Disclaimer

Conflict of interest statement

A.L. reports consultancies from AstraZeneca, Boehringer‐Ingelheim, Chiesi and Novartis, outside the submitted work. J.V. reports consultancies from Boehringer‐Ingelheim outside the submitted work. P.W. reports consultancies from AstraZeneca, Chiesi Pharmaceuticals outside the submitted work. C.M.S. reports consultancies from Boehringer‐Ingelheim, GlaxoSmithKline, Novartis, AstraZeneca, Roche and Genzyme outside the submitted work. P.W. has a patent Device and method for pulmonary capacity measurements issued. All other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Adjusted odds ratios (ORs) from multivariable logistic regression models for any respiratory symptom among all subjects in relation to different ratios of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used FEV1/FVC = 0.70 as the reference point. The model is adjusted for age, sex, BMI, asthma, smoking and pack‐years
FIGURE 2
FIGURE 2
Adjusted odds ratios (ORs) from multivariable logistic regression models for any respiratory symptom among never‐smokers in relation to different ratios of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used FEV1/FVC = 0.70 as the reference point. The model is adjusted for age, sex, BMI and asthma
FIGURE 3
FIGURE 3
Adjusted odds ratios (ORs) from multivariable logistic regression models for any respiratory symptom among ever‐smokers in relation to different ratios of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used FEV1/FVC = 0.70–0.75 as the reference point. The model is adjusted for age, sex, BMI, asthma, smoking and pack‐years
FIGURE 4
FIGURE 4
Forest plot of odds ratios (OR) among all subjects for any respiratory symptom, cough with phlegm, dyspnoea or wheeze accordissng to intervals of the forced expiratory volume in 1 s (ratio FEV1)/forced vital capacity (FVC) ratios using 0.70–0.75 as the reference interval. All models are adjusted for age, sex, body mass index, asthma, smoking and pack‐years
FIGURE 5
FIGURE 5
Forest plot of odds ratios (OR) among never‐smokers for any respiratory symptom, cough with phlegm, dyspnoea or wheeze according to intervals of the forced expiratory volume in 1 s (ratio FEV1)/forced vital capacity (FVC) ratios using 0.70–0.75 as the reference interval. All models are adjusted for age, sex, body mass index and asthma
FIGURE 6
FIGURE 6
Forest plot of odds ratios (OR) among ever‐smokers for any respiratory symptom, cough with phlegm, dyspnoea or wheeze according to intervals of the forced expiratory volume in 1 s (ratio FEV1)/forced vital capacity (FVC) ratios using 0.70–0.75 as the reference interval. All models are adjusted for age, sex, body mass index, asthma, smoking and pack‐years
See this image and copyright information in PMC

References

    1. Bergström, G. , Berglund, G. , Blomberg, A. , Brandberg, J. , Engström, G. , Engvall, J. , Eriksson, M. , de Faire, U. , Flinck, A. , Hansson, M. G. , Hedblad, H. O. , Janson, C. , Jernberg, T. , Johnson, Å. , Johansson, L. , Lind, L. , Löfdahl, C. G. , Mellander, O. , Östgren, C. J. , … Rosengren, A. (2015). The Swedish CArdioPulmonary BioImage Study (SCAPIS): Objectives and design. Journal of Internal Medicine, 278, 645–659. - PMC - PubMed
    1. Bestall, J. C. , Paul, E. A. , Garrod, R. , Garnham, R. , Jones, P. W. , & Wedzicha, J. A. (1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 54, 581–586. - PMC - PubMed
    1. Bhatt, S. P. , Balte, P. P. , Schwartz, J. E. , Cassano, P. A. , Couper, D. , Jacobs, D. R. Jr , Kalhan, R. , O'Connor, G. T. , Yende, S. , Sanders, J. L. , Umans, J. G. , Dransfield, M. T. , Chaves, P. H. , White, W. B. , & Oelsner, E. C. (2019). Discriminative accuracy of FEV1:FVC thresholds for COPD‐related hospitalization and mortality. JAMA, 321, 2438–2447. - PMC - PubMed
    1. Bhatt, S. P. , Sieren, J. C. , Dransfield, M. T. , Washko, G. R. , Newell, J. D. , & Stinson, D. S. (2014). Comparison of spirometric thresolds in diagnosing smoking‐related airflow obstruction. Thorax, 69, 409–414. - PMC - PubMed
    1. Björk, J. , Strömberg, U. , Rosengren, A. , Torén, K. , Fagerberg, B. , Grimby‐Ekman, A. , & Bergström, G. (2017). Predicting participation in the population‐based Swedish cardiopulmonary bio‐image study (SCAPIS) using register data. Scandinavian Journal of Public Health, 45(Suppl 17), 45–49. 10.1177/1403494817702326 - DOI - PubMed