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Post-Bronchodilator Spirometry Reference Values in Adults and Implications for Disease Management

Institute of Medicine and Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen; Department of Thoracic Medicine and Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

Correspondence and requests for reprints should be addressed to Ane Johannessen, M.Phil., Centre for Clinical Research, Haukeland University Hospital, N-5021 Bergen, Norway. E-mail: Ane.Johannessen{at}helse-bergen.no

Rationale: International guidelines promote the use of post-bronchodilator spirometry values in the definition and severity classification of chronic obstructive pulmonary disease. However, post-bronchodilator reference values have not yet been developed.

Objectives: To derive reference values for post-bronchodilator forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC, and to compare these reference values with locally derived and existing pre-bronchodilator reference values.

Methods: Based on a random sample of a general adult population, 2,235 subjects (70% of invited subjects) performed spirometry with reversibility testing. A reference population of healthy never-smokers constituted 23% of the study population (n = 515). Reference values for median and lower-limit-of-normal pre- and post-bronchodilator lung function and bronchodilator response were modeled using quantile regression analyses.

Main Results: The reference population had equal proportions of men and women in the age range 26–82 yr. Both FEV₁ and FVC decreased with age and increased with height. FEV₁/FVC decreased with age, although this trend was not statistically significant for men after bronchodilatation. Linear models gave the best overall fit. Lower-limit-of-normal post-bronchodilator FEV₁/FVC exceeded 0.7 for both sexes. Post-bronchodilator prediction equations gave higher predicted FEV₁ and FEV₁/FVC than both locally derived and existing pre-bronchodilator equations. The bronchodilator response decreased with age.

Conclusions: The present study is the first to develop reference values for post-bronchodilator lung function. Post-bronchodilator prediction equations can facilitate better management of patients with chronic obstructive pulmonary disease by avoiding falsely high FEV₁% predicted with a subsequent underestimation of disease severity.

Key Words: COPD • quantile regression • reference values • reversibility test • spirometry

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