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Vital capacity and COPD: the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Journal article
Authors Kjell Torén
Anna-Carin Olin
A. Lindberg
Jenny Vikgren
Linus Schiöler
John Brandberg
Åse (Allansdotter) Johnsson
G. Engstrom
H. L. Persson
M. Skold
Jan A Hedner
E. Lindberg
A. Malinovschi
E. Piitulainen
P. Wollmer
Annika Rosengren
C. Janson
A. Blomberg
Göran Bergström
Published in International Journal of Chronic Obstructive Pulmonary Disease
Volume 11
Issue 1
Pages 927-933
ISSN 1178-2005
Publication year 2016
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Medicine, Department of Public Health and Community Medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences, Section for Oncology, Radiation Physics, Radiology and Urology, Department of Radiology
Pages 927-933
Language en
Links dx.doi.org/10.2147/copd.s104644
Keywords obstructive, epidemiology, general population, air trapping, spirometry, slow vital capacity, asthma, lung-function tests, obstructive pulmonary-disease, regression, equations, respiratory society, smoking variables, reference values, standardization, spirometry, prevalence, statement, Respiratory System
Subject categories Clinical Medicine

Abstract

Background: Spirometric diagnosis of chronic obstructive pulmonary disease (COPD) is based on the ratio of forced expiratory volume in 1 second (FEV1)/vital capacity (VC), either as a fixed value <0.7 or below the lower limit of normal (LLN). Forced vital capacity (FVC) is a proxy for VC. The first aim was to compare the use of FVC and VC, assessed as the highest value of FVC or slow vital capacity (SVC), when assessing the FEV1/VC ratio in a general population setting. The second aim was to evaluate the characteristics of subjects with COPD who obtained a higher SVC than FVC. Methods: Subjects (n=1,050) aged 50-64 years were investigated with FEV1, FVC, and SVC after bronchodilation. Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPDFVC was defined as FEV1/FVC <0.7, GOLDCOPD(VC) as FEV1/VC <0.7 using the maximum value of FVC or SVC, LLNCOPDFVC as FEV1/FVC below the LLN, and LLNCOPDVC as FEV1/VC below the LLN using the maximum value of FVC or SVC. Results: Prevalence of GOLDCOPD(FVC) was 10.0% (95% confidence interval [CI] 8.2-12.0) and the prevalence of LLNCOPDFVC was 9.5% (95% CI 7.8-11.4). When estimates were based on VC, the prevalence became higher; 16.4% (95% CI 14.3-18.9) and 15.6% (95% CI 13.5-17.9) for GOLDCOPD(VC) and LLNCOPDVC, respectively. The group of additional subjects classified as having COPD based on VC, had lower FEV1, more wheeze and higher residual volume compared to subjects without any COPD. Conclusion: The prevalence of COPD was significantly higher when the ratio FEV1/VC was calculated using the highest value of SVC or FVC compared with using FVC only. Subjects classified as having COPD when using the VC concept were more obstructive and with indications of air trapping. Hence, the use of only FVC when assessing airflow limitation may result in a considerable under diagnosis of subjects with mild COPD.

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