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Thorax. 2007 Mar;62(3):237-41. Epub 2006 Nov 7.

Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function?

Author information

1
Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, 740 S Limestone, K-528, Lexington, KY 40536, USA. dmannino@uky.edu

Abstract

BACKGROUND:

The Global Initiative on Obstructive Lung Disease stages for chronic obstructive pulmonary disease (COPD) uses a fixed ratio of the post-bronchodilator forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) of 0.70 as a threshold. Since the FEV(1)/FVC ratio declines with age, using the fixed ratio to define COPD may "overdiagnose" COPD in older populations.

OBJECTIVE:

To determine morbidity and mortality among older adults whose FEV(1)/FVC is less than 0.70 but more than the lower limit of normal (LLN).

METHODS:

The severity of COPD was classified in 4965 participants aged > or =65 years in the Cardiovascular Health Study using these two methods and the age-adjusted proportion of the population who had died or had a COPD-related hospitalisation in up to 11 years of follow-up was determined.

RESULTS:

1621 (32.6%) subjects died and 935 (18.8%) had at least one COPD-related hospitalisation during the follow-up period. Subjects (n = 1134) whose FEV(1)/FVC fell between the LLN and the fixed ratio had an increased adjusted risk of death (hazard ratio (HR) 1.3, 95% CI 1.1 to 1.5) and COPD-related hospitalisation (HR 2.6, 95% CI 2.0 to 3.3) during follow-up compared with asymptomatic individuals with normal lung function.

CONCLUSION:

In this cohort, subjects classified as "normal" using the LLN but abnormal using the fixed ratio were more likely to die and to have a COPD-related hospitalisation during follow-up. This suggests that a fixed FEV(1)/FVC ratio of <0.70 may identify at-risk patients, even among older adults.

PMID:
17090573
PMCID:
PMC2117148
DOI:
10.1136/thx.2006.068379
[Indexed for MEDLINE]
Free PMC Article

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