Pérez-Padilla Rogelio, Torre Bouscoulet Luis, Vázquez-García Juan Carlos, Muiño Adriana, Márquez María, López María Victorina, Montes de Oca María, Tálamo Carlos, Valdivia Gonzalo, Pertuze Julio, Jardim José, Menezes Ana María B
Instituto Nacional de Enfermedades Respiratorias, México DF, México.
Arch Bronconeumol. 2007 Oct;43(10):530-4. doi: 10.1016/s1579-2129(07)60123-2.
The criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV1) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values.
A cluster sample of subjects aged 40 years or over was chosen to be representative of the metropolitan areas of 5 Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, and Caracas). Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 microg of salbutamol. Multiple linear regression equations were fitted for the postbronchodilator spirometric values-FEV1, forced expiratory volume in 6 seconds (FEV6), peak expiratory flow rate, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease.
The postbronchodilator reference values for FEV1, FEV1/FVC, and FEV1/FEV6 were on average 3% higher than those obtained before bronchodilation. This apparently small difference caused an upward shift in the 5th percentile (lower limit of normal) of the predicted values. When prebronchodilation instead of postbronchodilation reference values were used, 3.2% of the results for airflow obstruction in our population of over-40-year-olds were false negatives.
The reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.
慢性阻塞性肺疾病全球倡议组织制定的疾病严重程度标准是基于使用支气管扩张剂后1秒用力呼气量（FEV1）占预测值的百分比。本研究旨在确定支气管扩张剂使用后肺量计的参考值。
选取40岁及以上受试者的整群样本，以代表5个拉丁美洲城市（圣保罗、墨西哥城、蒙得维的亚、圣地亚哥和加拉加斯）的大都市区。按照美国胸科学会的建议，对5183名受试者在吸入200微克沙丁胺醇前后进行肺量计检查。对支气管扩张剂使用后的肺量计测量值——FEV1、6秒用力呼气量（FEV6）、呼气峰值流速、用力肺活量（FVC）、FEV1/FEV6、FEV1/FVC以及肺活量25%至75%之间的用力呼气流量（FEF25 - 75）拟合多元线性回归方程。在887名无肺部疾病史的无症状受试者中，根据性别、年龄和身高进行了调整。
支气管扩张剂使用后的FEV1、FEV1/FVC和FEV1/FEV6参考值平均比支气管扩张前获得的值高3%。这一明显微小的差异导致预测值的第5百分位数（正常下限）向上偏移。当使用支气管扩张前而非支气管扩张后的参考值时，在我们40岁以上人群中，气流受限结果的3.2%为假阴性。
报告的参考值更适用于支气管扩张剂使用后的肺量计检查，并有可能减少错误分类的数量。
