TY - JOUR T1 - Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary bioImage Study (SCAPIS) JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01995-2019 VL - 56 IS - 2 SP - 1901995 AU - Andrei Malinovschi AU - Xingwu Zhou AU - Björn Bake AU - Göran Bergström AU - Anders Blomberg AU - Jonas Brisman AU - Kenneth Caidahl AU - Gunnar Engström AU - Maria J. Eriksson AU - Andreas Frølich AU - Christer Janson AU - Kjell Jansson AU - Jenny Vikgren AU - Anne Lindberg AU - Robert Linder AU - Maria Mannila AU - Hans L. Persson AU - C. Magnus Sköld AU - Kjell Torén AU - Carl J. Östgren AU - Per Wollmer AU - Jan E. Engvall Y1 - 2020/08/01 UR - http://erj.ersjournals.com/content/56/2/1901995.abstract N2 - The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide (DLCO). Lower limit of normal (LLN), i.e. the 5th percentile, usually defines impaired DLCO. We examined if the GLI LLN for DLCO differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.Spirometry, DLCO, chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15 040 participants, aged 50–64 years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).Both the median and LLN for DLCO from SCAPIS were above the median and LLN from the GLI (p<0.05). The prevalence of DLCO <GLI LLN (and also <SCAPIS LLN) was 3.9%, while the prevalence of DLCO >GLI LLN but <SCAPIS LLN was 5.7%. Subjects with DLCO >GLI LLN but <SCAPIS LLN (n=860) had more emphysema (14.3% versus 4.5%, p<0.001), chronic airflow limitation (8.5% versus 3.9%, p<0.001) and chronic bronchitis (8.3% versus 4.4%, p<0.01) than subjects (n=13 600) with normal DLCO (>GLI LLN and >SCAPIS LLN). No differences were found with regard to physician-diagnosed asthma.The GLI LLN for DLCO is lower than the estimated LLN in healthy, never-smoking, middle-aged Swedish adults. Individuals with DLCO above the GLI LLN but below the SCAPIS LLN had, to a larger extent, an increased respiratory burden. This suggests clinical implications for choosing an adequate LLN for studied populations.The LLN for DLCO is above the GLI LLN in never-smoking, middle-aged Swedish adults. Individuals with DLCO above the GLI LLN but below the SCAPIS LLN had an increased burden of respiratory disease, suggesting clinical implications for the present findings. https://bit.ly/39B455B ER -