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Claudio Pedone, MD, PhD; Simone Scarlata, MD; Domenica Chiurco, MD; Maria Elisabetta Conte, MD; Francesco Forastiere; Raffaele Antonelli-Incalzi
Author and Funding Information

From the Unit of Respiratory Pathophysiology (Drs Pedone, Scarlata, Chiurco, and Conte and Antonelli-Incalzi), Università Campus Biomedico; the “Alberto Sordi” Foundation (Drs Pedone and Scarlata); the Department of Epidemiology (Dr Forastiere), Roma E. Health Authority; and Fondazione San Raffaele (Dr Antonelli-Incalzi), Cittadella della Carità.

Correspondence to: Claudio Pedone, MD, PhD, Università Campus Bio Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; e-mail: c.pedone@unicampus.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1354-1355. doi:10.1378/chest.12-1853
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Published online
To the Editor:

We thank Dr Hardie for his suggestion to expand the analyses we presented in our article in CHEST1 to test the hypothesis that people with FVC < the lower limit of normal (LLN) but without true restriction (total lung capacity [TLC] > LLN) do not have an increased risk of death. Indeed, compared with people with normal TLC and normal FVC, those with a reduced FVC (but normal TLC) do not have an increased risk of death (mortality rate ratio, 0.86; 95% CI, 0.12-3.66). People with decreased TLC and normal FVC, on the contrary, have a sixfold increased mortality risk (mortality rate ratio, 6.68; 95% CI, 2.36-19.4). Compared with patients with FVC < LLN and TLC ≥ LLN, those with FVC < LLN and TLC < LLN had a mortality rate ratio of 7.78 (95% CI, 1.9-56.67). Although the estimates may not be completely reliable because of the small number of events (only two deaths in the group with TLC > LLN and FVC < LLN), these results seem to support the hypothesis that the association between reduced FVC and mortality repeatedly reported in the literature is supported by the association between TLC and mortality.

As for the figure, because of the small number of events, the reference lines are actually very similar but not identical. For example, at close scrutiny it can be seen that the reference curve in the first panel (FVC ≥ LLN) has one “step” fewer in the first 6 months of follow-up.

References

Pedone C, Scarlata S, Chiurco D, Conte ME, Forastiere F, Antonelli-Incalzi R. Association of reduced total lung capacity with mortality and use of health services. Chest. 2012;141(4):1025-1030. [CrossRef] [PubMed]
 

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References

Pedone C, Scarlata S, Chiurco D, Conte ME, Forastiere F, Antonelli-Incalzi R. Association of reduced total lung capacity with mortality and use of health services. Chest. 2012;141(4):1025-1030. [CrossRef] [PubMed]
 
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