James E Hansen1, Janos Porszasz1, Richard Casaburi1, William W Stringer1. 1. Respiratory and Critical Care Division, Department of Medicine, Los Angeles Biomedical Research Institute-Harbor, University of California -Los Angeles Medical Center,Torrance, California; University of California-Los Angeles David Geffen School of Medicine, Los Angeles.
Abstract
Background: Spirometric values of 5880 never-smoking black, Latin, and white men and women in the Third National Health and Nutrition Examination Survey (NHANES-3) reference population were reviewed. Good published equations for forced expiratory volume in 1 second (FEV1) over forced expiratory volume in 6 seconds (FEV6) and FEV1over forced vital capacity (FVC) often significantly mis-identified the lower limit of normal (LLN) targets in both younger and older adults. To improve detection of smaller airways disease in adults, we wished to redefine the LLN for these ratios and develop new ones for forced expiratory volume in 3 seconds (FEV3)/FEV6 and FEV3/FVC. Methods: In each of 6 ethnic/gender, never-smoking NHANES-3 groups, arranged sequentially by age from 20.0 to 79.9 years, the values of FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC were placed in groups of 40 so that the actual lowest second (5%) ratios could be identified. The slopes and intercepts of the resulting 24 linear equations through these lowest 5% ratios were then each adjusted by multiple iterations to best identify equations which actually identified the lowest 5% in both younger and older adults. Results: In all never-smokers, the new equations were closer to the 5% LLN targets than were those of Hankinson for FEV1/FEV6 and FEV1/FVC and Quanjer for FEV1/FVC. In 3508 NHANES-3 current smokers, the FEV3/FEV6 and FEV3/FVC identified significantly more values below LLN than the FEV1/FEV6 and FEV1/FVC. Conclusion: New simple linear iterative equations for FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC to identify LLN are offered. None require exponents or logarithms. The latter 2 detected more abnormalities in current-smokers and likely better identify small airways disease in adults.
Background: Spirometric values of 5880 never-smoking black, Latin, and white men and women in the Third National Health and Nutrition Examination Survey (NHANES-3) reference population were reviewed. Good published equations for forced expiratory volume in 1 second (FEV1) over forced expiratory volume in 6 seconds (FEV6) and FEV1over forced vital capacity (FVC) often significantly mis-identified the lower limit of normal (LLN) targets in both younger and older adults. To improve detection of smaller airways disease in adults, we wished to redefine the LLN for these ratios and develop new ones for forced expiratory volume in 3 seconds (FEV3)/FEV6 and FEV3/FVC. Methods: In each of 6 ethnic/gender, never-smoking NHANES-3 groups, arranged sequentially by age from 20.0 to 79.9 years, the values of FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC were placed in groups of 40 so that the actual lowest second (5%) ratios could be identified. The slopes and intercepts of the resulting 24 linear equations through these lowest 5% ratios were then each adjusted by multiple iterations to best identify equations which actually identified the lowest 5% in both younger and older adults. Results: In all never-smokers, the new equations were closer to the 5% LLN targets than were those of Hankinson for FEV1/FEV6 and FEV1/FVC and Quanjer for FEV1/FVC. In 3508 NHANES-3 current smokers, the FEV3/FEV6 and FEV3/FVC identified significantly more values below LLN than the FEV1/FEV6 and FEV1/FVC. Conclusion: New simple linear iterative equations for FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC to identify LLN are offered. None require exponents or logarithms. The latter 2 detected more abnormalities in current-smokers and likely better identify small airways disease in adults.
Entities:
Keywords:
airway obstruction; lower limit of normal; small airways disease; spirometry
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