Defining obstructive ventilatory defect in 2015

Figures & data

Table 1 Anthropometric and spirometric data of included subjects divided according to age ranges (n=4,730)

	Anthropometric data					FEV1		FVC		FEV1/FVC
Age range (years)	Sex	Age (year)	Height (m)	Weight (kg)	BMI	(L)	%	(L)	%	Absolute value	Group I (FEV1/FVC<0.70)	Group II (FEV1/FVC<LLN)	Probability
	M (n=189)	21.5±2.1	1.75±0.07	71±12	23.2±3.3	4.27±0.53	89±10	4.97±0.65	90±10	0.86±0.05	0 (0.00)	6 (3.19)*	0.0169
17–25	F (n=111)	21.0±1.9	1.65±0.08	61±10	22.6±3.6	3.40±0.60	90±12	3.86±0.67	88±11	0.88±0.05	0 (0.00)	0 (0.00)	1
	T (n=300)	21.3±2.0	1.71±0.09	68±12	23.0±3.4	3.95±0.70	90±11	4.56±0.85	89±10	0.86±0.05	0 (0.00)	6 (2.00)*	0.0141
	M (n=556)	30.0±2.8	1.74±0.07	78±14	25.6±4.0	4.00±0.62	88±11	4.85±0.77	92±11	0.82±0.06	17 (3.05)	47 (8.45)*	0.003
25–35	F (n=182)	30.5±2.9	1.65±0.08	68±12	25.2±4.0	3.30±0.91	94±17	3.91±0.91	95±17	0.84±0.05	3 (1.64)	8 (4.39)	0.2641
	T (n=738)	30.1±2.8	1.72±0.08	75±14	25.5±4.0	3.82±0.71	90±13	4.62±0.90	93±13	0.83±0.06	20 (2.71)	55 (7.45)*	0.003
	M (n=768)	40.1±2.7	1.71±0.07	80±14	27.2±4.3	3.51±0.69	84±15	4.37±0.77	90±13	0.80±0.07	84 (10.93)	118 (15.36)*	0.0199
35–45	F (n=270)	39.8±2.7	1.62±0.08	73±12	27.8±4.3	3.00±0.71	94±19	3.61±0.85	95±18	0.83±0.06	9 (3.33)	20 (7.40)*	0.0334
	T (n=1038)	40.1±2.7	1.69±0.09	78±14	27.4±4.3	3.38±0.73	86±16	4.17±0.86	91±15	0.81±0.07	93 (8.58)	138 (13.29)*	0.036
	M (n=870)	49.6±2.8	1.71±0.06	78±14	26.6±4.5	2.93±0.88	75±21	3.83±0.83	84±16	0.75±0.13	197 (22.64)	229 (26.32)	0.1459
45–55	F (n=484)	49.5±3.0	1.59±0.08	73±11	28.7±4.2	2.57±0.61	89±17	3.11±0.75	91±17	0.82±0.06	12 (2.47)	20 (4.13)	0.0685
	T (n=1354)	49.6±2.8	1.67±0.09	76±13	27.4±4.5	2.80±0.81	80±21	3.58±0.88	86±17	0.77±0.11	209 (15.43)	249 (18.38)*	0.0356
	M (n=458)	58.7±2.7	1.68±0.07	75±14	26.7±4.7	2.44±0.87	67±23	3.30±0.84	78±18	0.72±0.14	157 (34.27)	162 (35.37)	0.7503
55–65	F (n=256)	58.8±2.8	1.58±0.08	71±12	28.2±4.5	2.26±0.61	87±19	2.74±0.72	88±18	0.82±0.09	16 (6.25)	19 (7.42)	0.6465
	T (n=714)	58.7±2.7	1.65±0.09	74±14	27.2±4.7	2.38±0.79	74±23	3.10±0.84	82±18	0.76±0.14	173 (24.22)	181 (25.35)	0.6605
	M (n=328)	68.5±2.6	1.67±0.07	71±12	25.5±4.4	1.71±0.78	54±25	2.59±0.84	67±21	0.64±0.14	197 (60.06)	190 (57.92)	0.6027
65–75	F (n=104)	68.1±2.3	1.56±0.09	65±11	26.9±3.9	1.99±0.71	87±24	2.44±0.80	89±21	0.81±0.10	9 (8.65)	9 (8.65)	1
	T (n=432)	68.4±2.6	1.64±0.09	69±12	25.8±4.4	1.78±0.77	62±28	2.55±0.83	73±23	0.68±0.15	206 (47.68)	199 (46.06)	0.5561
	M (n=129)	77.9±2.7	1.64±0.06	69±10	25.5±3.8	1.47±0.63	62±17	2.30±0.56	72±18	0.62±0.17	83 (64.34)	78 (60.46)	0.5087
75–85	F (n=25)	78.4±2.3	1.48±0.04	62±7	28.3±2.9	1.38±0.23	80±14	1.58±0.28	74±15	0.87±0.05	0 (0.00)	0 (0.00)	1
	T (n=154)	78.0±2.7	1.62±0.08	68±9	25.9±3.8	1.46±0.58	64±27	2.18±0.59	66±18	0.66±0.18	83 (53.89)	78 (50.64)	0.5985
	M (n=3298)	46.7±14.4	1.71±0.07	76±14	26.2±4.4	3.07±1.09	76±22	3.94±1.10	84±17	0.76±0.12	735 (22.28)	830 (25.16)*	0.0041
17–85	F (n=1432)	46.6±13.4	1.60±0.08	70±12	27.4±4.5	2.69±0.79	90±18	3.23±0.93	91±18	0.83±0.07	49 (3.42)	76 (5.30)*	0.0064
	T (n=4730)	46.7±14.1	1.67±0.09	75±14	26.6±4.5	2.96±1.02	90±22	3.72±1.10	86±18	0.78±0.12	784 (16.57)	906 (19.15)*	0.0114

BMI, body mass index in kg/m²; F, Female; FEV₁, first-second forced expiratory volume; FVC, forced vital capacity; LLN, lower limit of normal; M, male; T, total sample. Quantitative data are mean±SD. Groups I and II data are number (%). *Probability (chi-square) <0.05: ‘FEV₁/FVC<0.70’ vs. ‘FEV₁/FVC<LLN’.

Table 2 Anthropometric and spirometric data of included subjects divided according to OVD definitions (n=4,730)

		Group III ‘physio (+), operat (−)’	Group IV ‘physio (−), operat (+)’	Group V ‘physio (+), operat (+)’	Group VI ‘physio (−), operat (−)’
		FEV1/FVC<LLN and FEV1/FVC≥0.70 (n=136)	FEV1/FVC<0.70 and FEV1/FVC≥LLN (n=14)	FEV1/FVC<0.70 and FEV1/FVC<LLN (n=770)	FEV1/FVC≥0.70 and FEV1/FVC≥LLN (n=3,810)
Sex	Male	109 (80)	14 (100)*	721 (94)	2,454 (64)*
	Female	27 (20)	0 (0)*	49 (16)	1,356 (36)*
Smoking status	Smoker	39 (29)	13 (93)*	544 (71)	544 (14)*
	Non-smoker	97 (71)	1 (7)*	226 (29)	3,266 (86)*
Age	(year)	40.9±10.3	74.2±4.7^a	57.8±11.9	44.5±13.4^b
Height	(m)	1.71±0.09	1.67±0.02^a	1.69±0.07	1.67±0.09^b
Weight	(kg)	79±16	75±6	70±14	75±14^b
BMI	(kg/m^2)	26.8±4.6	26.7±2.0	24.8±4.6	27.0±4.4^b
FEV1	(L)	3.13±0.78	1.68±0.33^a	1.73±0.84	3.21±0.87^b
	(%)	78±17	62±13^a	48±20	87±16^b
FVC	(L)	4.37±1.07	2.49±0.49^a	2.99±1.10	3.85±1.04^b
	(%)	93±19	71±15^a	71±22	89±15^b
FEV1/FVC (absolute value)		0.71±0.01	0.67±0.00^a	0.56±0.10	0.83±0.05^b

BMI, body mass index; FEV₁, first-second forced expiratory volume; FVC, forced vital capacity; OVD, obstructive ventilatory defect; LLN, lower limit of normal. Data are mean±SD, except for sex and smoking status, where data are number (%). ^aProbability (Mann–Whitney U test)<0.05: Group III vs. Group IV. ^bProbability (t-test)<0.05: Group V vs. Group VI. *Probability (chi-square) <0.05: Group III vs. Group IV or Group V vs. Group VI.

Fig. 1 Distribution of included subjects with respect to obstructive ventilatory defect definitions and smoking status: (a) operational definition ‘negative’; (b) operational definition ‘positive’.

FEV1, first-second forced expiratory volume; FVC, forced vital capacity; LLN, lower limit of normal; n, number; %: percentage of smokers with OVD; FEV1/FVC LLN values are mean±SD.

Table 3 Results of some studies aiming to compare the OVD operational and physiological definitions

First author	Miller (49)	Lau (48)	Szanto (51)	Roberts (50)	Aggarwal (46)	Present study
Year of study	NR	2001–2003	2001–2002	2003–2004	1999–2008	2006–2015
Country	United Kingdom USA New Zealand	Hong Kong	Sweden	USA	India	Tunisia
Study design	Retrospective	Prospective	Retrospective	Retrospective	Retrospective	Retrospective/partially prospective
Sample size (male/female)	11,413 (6,026/5,387)	525 (525/0)	574 (226/348)	1,503 (796/707)	27,307 (27,307/0)	4,730 (3,298/1,432)
Inclusion criteria	White adults	Smokers Ex-smokers	NR	NR	Male Age>15 years	Age>17 years
Exclusion criteria	Non-white Lack of cooperation	Asthma COPD Pulmonary tuberculosis Lung fibrosis Spinal abnormalities History of pleurodesis or chest tube insertion or thoracic surgery Acute illness (past 3 months) Respiratory tract infection (past 4 weeks)	Lack of cooperation	Inaccurate tests Uninterpretable tests	Age≤15 years	Lack of cooperation
Applied spirometric guidelines	ATS/ERS 2005 (35)	ATS-1995 (61)	ATS-1995 (61)	ATS-1995 (61)	ATS-1995 (61) ATS/ERS-2005 (35)	.ATS/ERS-2005 (35)
Applied spirometric norms	European norms (40) USA norms (62)	Local norms (63)	ECSC (40) Local norms (64–66)	Local norms (62, 67–69)	Local norms (70)	Local norms (20, 26) (38)
Age ranges (years)	20–92	20–80	60–93	14–95	15–95	17–85
Percentages of subjects with an OVD
Operational definition	38	19	23	40	37	17
Physiological definition	32	14	10	37 (69) to 43 (74)	33	19
Significant difference between definitions	Yes	Yes	Yes	No	Yes	Yes

COPD, chronic obstructive pulmonary disease; ECCS, European-Community for Coal and Steel; OVD, obstructive ventilatory defect; NR, not reported.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, etal. Standardisation of spirometry. Eur Respir J. 2005; 26: 319–38.

 Google Scholar

No authors listed. Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med. 1995; 152: 1107–36.

 Web of Science ®Google Scholar

Quanjer P. Standardized lung function testing. Report working party standardization of lung function tests, European community for coal and steel. Bull Europ Physiopathol Respir. 1983; 19: 1–95.

 PubMedGoogle Scholar

Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999; 159: 179–87.

 Google Scholar

Ip MS, Ko FW, Lau AC, Yu WC, Tang KS, Choo K, etal. Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest. 2006; 129: 384–92.

 Google Scholar

Berglund E, Birath G, Bjure J, Grimby G, Kjellmer I, Sandqvist L, etal. Spirometric studies in normal subjects. I. Forced expirograms in subjects between 7 and 70 years of age. Acta Med Scand. 1963; 173: 185–92.

 Google Scholar

Hedenstrom H, Malmberg P, Fridriksson HV. Reference values for lung function tests in men: regression equations with smoking variables. Ups J Med Sci. 1986; 91: 299–310.

 Google Scholar

Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis. 1981; 123: 659–64. [PubMed Abstract].

 Google Scholar

Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971; 103: 57–67. [PubMed Abstract].

 Google Scholar

Aggarwal AN, Gupta D, Jindal SK. Development of a simple computer program for spirometry interpretation. J Assoc Physicians India. 2002; 50: 567–70. [PubMed Abstract].

 Google Scholar

El Attar MN, Hadj Mabrouk K, Ben Abdelaziz A, Abdelghani A, Bousarssar M, Limam K, etal. Applicability of the old European respiratory society/European community for steel and coal reference equations for spirometry interpretation in Tunisian adult population. Tunis Med. 2014; 92: 574–80. [PubMed Abstract].

 Google Scholar

Ben Saad H, El Attar MN, Hadj Mabrouk K, Ben Abdelaziz A, Abdelghani A, Bousarssar M, etal. The recent multi-ethnic global lung initiative 2012 (GLI2012) reference values don't reflect contemporary adult's North African spirometry. Respir Med. 2013; 107: 20–8.

 Web of Science ®Google Scholar

Tabka Z, Hassayoune H, Guenard H, Zebidi A, Commenges D, Essabah H, etal. Spirometric reference values in a Tunisian population. Tunis Med. 1995; 73: 125–31. [PubMed Abstract].

 Google Scholar