Swanney M P, Ruppel G, Enright P L, Pedersen O F, Crapo R O, Miller M R, Jensen R L, Falaschetti E, Schouten J P, Hankinson J L, Stocks J, Quanjer P H
Respiratory Physiology Laboratory, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand.
Thorax. 2008 Dec;63(12):1046-51. doi: 10.1136/thx.2008.098483. Epub 2008 Sep 11.
The prevalence of airway obstruction varies widely with the definition used.
To study differences in the prevalence of airway obstruction when applying four international guidelines to three population samples using four regression equations.
We collected predicted values for forced expiratory volume in 1 s/forced vital capacity (FEV(1)/FVC) and its lower limit of normal (LLN) from the literature. FEV(1)/FVC from 40 646 adults (including 13 136 asymptomatic never smokers) aged 17-90+years were available from American, English and Dutch population based surveys. The prevalence of airway obstruction was determined by the LLN for FEV(1)/FVC, and by using the Global Initiative for Chronic Obstructive Lung Disease (GOLD), American Thoracic Society/European Respiratory Society (ATS/ERS) or British Thoracic Society (BTS) guidelines, initially in the healthy subgroup and then in the entire population.
The LLN for FEV(1)/FVC varied between prediction equations (57 available for men and 55 for women), and demonstrated marked negative age dependency. Median age at which the LLN fell below 0.70 in healthy subjects was 42 and 48 years in men and women, respectively. When applying the reference equations (Health Survey for England 1995-1996, National Health and Nutrition Examination Survey (NHANES) III, European Community for Coal and Steel (ECCS)/ERS and a Dutch population study) to the selected population samples, the prevalence of airway obstruction in healthy never smokers aged over 60 years varied for each guideline: 17-45% of men and 7-26% of women for GOLD; 0-18% of men and 0-16% of women for ATS/ERS; and 0-9% of men and 0-11% of women for BTS. GOLD guidelines caused false positive rates of up to 60% when applied to entire populations.
Airway obstruction should be defined by FEV(1)/FVC and FEV(1) being below the LLN using appropriate reference equations.
气道阻塞的患病率因所采用的定义不同而有很大差异。
使用四个回归方程，将四项国际指南应用于三个总体样本，研究气道阻塞患病率的差异。
我们从文献中收集了1秒用力呼气容积/用力肺活量（FEV(1)/FVC）及其正常下限（LLN）的预测值。来自美国、英国和荷兰基于人群的调查，获得了40646名年龄在17 - 90岁以上成年人（包括13136名无症状从不吸烟者）的FEV(1)/FVC。气道阻塞的患病率由FEV(1)/FVC的LLN以及使用慢性阻塞性肺疾病全球倡议（GOLD）、美国胸科学会/欧洲呼吸学会（ATS/ERS）或英国胸科学会（BTS）指南来确定，最初在健康亚组中，然后在整个人口中。
FEV(1)/FVC的LLN在预测方程之间有所不同（男性有57个，女性有55个），并且显示出明显的年龄负相关性。在健康受试者中，LLN降至0.70以下的男性和女性的中位年龄分别为42岁和48岁。当将参考方程（1995 - 1996年英国健康调查、美国国家健康与营养检查调查（NHANES）III、欧洲煤钢共同体（ECCS）/ERS以及一项荷兰人群研究）应用于选定的总体样本时，60岁以上健康从不吸烟者的气道阻塞患病率因各指南而异：GOLD指南中，男性为17% - 45%，女性为7% - 26%；ATS/ERS指南中，男性为0% - 18%，女性为0% - 16%；BTS指南中，男性为0% - 9%，女性为0% - 11%。当应用于整个人口时，GOLD指南导致的假阳性率高达60%。
气道阻塞应以FEV(1)/FVC以及使用适当参考方程时FEV(1)低于LLN来定义。
