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Original Research: LUNG FUNCTION TESTING |

Spirometric Criteria for Airway Obstruction*: Use Percentage of FEV1/FVC Ratio Below the Fifth Percentile, Not < 70%

James E. Hansen, MD, FCCP; Xing-Guo Sun, MD; Karlman Wasserman, PhD, MD, FCCP
Author and Funding Information

*From the Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.

Correspondence to: James E. Hansen, MD, FCCP, Box 405, Harbor-UCLA Medical Center, Torrance, CA 90509; e-mail: jhansen@labiomed.org



Chest. 2007;131(2):349-355. doi:10.1378/chest.06-1349
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Background: Current authoritative spirometry guidelines use conflicting percentage of FEV1/FVC ratios (FEV1/FVC%) to define airway obstruction. The American Thoracic Society/European Respiratory Society Task Force characterizes obstruction as a FEV1/FVC% below the statistically defined fifth percentile of normal. However, many recent publications continue to use the Global Initiative for Chronic Obstructive Lung Disease (GOLD) primary criterion that defines obstruction as a FEV1/FVC% < 70%. Data from the Third National Health and Nutrition Examination Survey (NHANES-III) should identify and quantify differences, help resolve this conflict, and reduce inappropriate medical and public health decisions resulting from misidentification.

Methods: Using these two guidelines, individual values of FEV1/FVC% were compared by decades in 5,906 healthy never-smoking adults and 3,497 current-smokers of black (African American), Hispanic (Latin), or white ethnicities aged 20.0 to 79.9 years.

Results: In the never-smoking population, the lower limits of normal used in other reference equations fit reasonably well the NHANES-III statistically defined fifth percentile guidelines. But nearly one half of young adults with FEV1/FVC% below the NHANES-III fifth percentile of normal were misidentified as normal because their FEV1/FVC% was > 70% (abnormals misidentified as normal). Approximately one fifth of older adults with observed FEV1/FVC% above the NHANES-III fifth percentile had FEV1/FVC% ratios < 70% (normals misidentified as abnormal).

Conclusions: The GOLD guidelines misidentify nearly one half of abnormal younger adults as normal and misidentify approximately one fifth of normal older adults as abnormal.

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