Diagnosis of airway obstruction in the elderly: contribution of the SARA study

作者：Sorino Claudio^*; Battaglia Salvatore; Scichilone Nicola; Pedone Claudio; Antonelli Incalzi Raffaele; Sherrill Duane; Bellia Vincenzo

来源：International Journal of COPD, 2012, 7: 389-395.

DOI：10.2147/COPD.S31630

• aging
• airflow obstruction
• chronic obstructive pulmonary disease
• forced expiratory volume
• lung function tests
• spirometry

Background: The choice between lower limit of normal or fixed value of forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC) %26lt; 0.70 as the criterion for confirming airway obstruction is an open issue. In this study, we compared the criteria of lower limit of normal and fixed FEV1/FVC for diagnosis of airway obstruction, with a focus on healthy elderly people. %26lt;br%26gt;Methods: We selected 367 healthy nonsmoking subjects aged 65-93 years from 1971 participants in the population-based SARA (Salute Respiratoria nell%26apos;Anziano, Italian for %26quot;Respiratory Health in the Elderly%26quot;) study, analyzed their spirometric data, and tested the relationship between spirometric indices and anthropometric variables. The lower limit of normal for FEV1/FVC was calculated as the fifth percentile of the normal distribution for selected subjects. %26lt;br%26gt;Results: While FEV1 and FVC decreased significantly with aging, the relationship between FEV1/FVC and age was not statistically significant in men or women. The lower limit of normal for FEV1/FVC was 0.65 in men and 0.67 in women. Fifty-five participants (15%) had FEV1/FVC %26lt; 0.70 and would have been inappropriately classified as obstructed according to the Global Initiative for Obstructive Lung Disease, American Thoracic Society/European Respiratory Society, and Canadian guidelines on chronic obstructive pulmonary disease. By applying different FEV1/FVC thresholds for the different age groups, as previously proposed in the literature, (0.70 for %26lt;70 years, 0.65 for 70-80 years, and 0.60 for %26gt;80 years) the percentage of patients classified as obstructed decreased to 6%. No subjects older than 80 years had an FEV1/FVC %26lt; 0.60. %26lt;br%26gt;Conclusion: The present results confirm the inadequacy of FEV1/FVC %26lt; 0.70 as a diagnostic criterion for airway obstruction after the age of 65 years. FEV1 /FVC %26lt; 0.65 and %26lt;0.67 (for men and women, respectively) could identify subjects with airway obstruction in such a population. Further reduction of the threshold after 80 years is not justified.

• 出版日期2012