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Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study

¹ Kaiser Permanente, Center for Health Research, Portland, OR, ⁴ The University of Arizona, Tucson, AZ, and ⁷ Oregon Health & Science University, Portland, OR, USA. ² University of Iceland, Medical Faculty, Landspitali University Hospital, Reykjavik, Iceland. ³ National Heart and Lung Institute, Imperial College, London, UK. ⁵ Institute of Medicine, University of Bergen, Bergen, Norway. ⁶ Cukurova University School of Medicine, Balcali, Adana, Turkey.

CORRESPONDENCE: W. M. Vollmer, Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227-1110, USA. E-mail: william.vollmer{at}kpchr.org

Keywords: Adult, chronic obstructive pulmonary disease, epidemiology

Received: October 30, 2008
Accepted April 27, 2009

Published guidelines recommend spirometry to accurately diagnose chronic obstructive pulmonary disease (COPD). However, even spirometry-based COPD prevalence estimates can vary widely. We compared properties of several spirometry-based COPD definitions using data from the international Burden of Obstructive Lung Disease (BOLD)study.

14 sites recruited population-based samples of adults aged 40 yrs. Procedures included standardised questionnaires and post-bronchodilator spirometry. 10,001 individuals provided usable data.

Use of the lower limit of normal (LLN) forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC) ratio reduced the age-related increases in COPD prevalence that are seen among healthy never-smokers when using the fixed ratio criterion (FEV₁/FVC <0.7) recommended by the Global Initiative for Chronic Obstructive Lung Disease. The added requirement of an FEV₁ either <80% predicted or below the LLN further reduced age-related increases and also led to the least site-to-site variability in prevalence estimates after adjusting for potential confounders. Use of the FEV₁/FEV₆ ratio in place of the FEV₁/FVC yielded similar prevalence estimates.

Use of the FEV₁/FVC<LLN criterion instead of the FEV₁/FVC <0.7 should minimise known age biases and better reflect clinically significant irreversible airflow limitation. Our study also supports the use of the FEV₁/FEV₆ as a practical substitute for the FEV₁/FVC.

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