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Published ahead of print on March 23, 2006, doi:10.1164/rccm.200601-023OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1316-1325

A more recent version of this article appeared on June 15, 2006
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Submitted on January 6, 2006
Accepted on March 23, 2006

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

Ane Johannessen1*, Sverre Lehmann2, Ernst R Omenaas1, Geir Egil Eide3, Per S Bakke2, and Amund Gulsvik2

1 Institute of Medicine, University of Bergen, Bergen, Norway; Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway, 2 Institute of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway, 3 Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway; Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

* To whom correspondence should be addressed. 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 (COPD). 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, 2235 subjects (70%) 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 (LLN) pre- and post-bronchodilator lung function and bronchodilator response were modelled using quantile regression analyses. Main Results: The reference population had equal proportions of men and women in the age range 26-82 years. 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. LLN 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 COPD patients by avoiding falsely high FEV1 % predicted with a subsequent underestimation of disease severity.
Key words: reference values, spirometry, COPD, reversibility test, quantile regression




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