• Am. J. Respir. Crit. Care Med. · Aug 2023

    Consequences of Using Post- or Pre-Bronchodilator Reference Values in Interpreting Spirometry.

    • Andrei Malinovschi, Xingwu Zhou, Anders Andersson, Helena Backman, Björn Bake, Anders Blomberg, Kenneth Caidahl, Maria J Eriksson, Jonas Eriksson Ström, Viktor Hamrefors, Ola Hjelmgren, Christer Janson, Reza Karimi, David Kylhammar, Anne Lindberg, Eva Lindberg, Per Liv, Anna-Carin Olin, Adel Shalabi, C Magnus Sköld, Johan Sundström, Hanan Tanash, Kjell Torén, Per Wollmer, Suneela Zaigham, Carl Johan Östgren, and Jan E Engvall.
    • Department of Medical Sciences, Clinical Physiology.
    • Am. J. Respir. Crit. Care Med. 2023 Aug 15; 208 (4): 461471461-471.

    AbstractRationale: Postbronchodilator spirometry is used for the diagnosis of chronic obstructive pulmonary disease. However, prebronchodilator reference values are used for spirometry interpretation. Objectives: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or postbronchodilator reference values generated within SCAPIS (Swedish CArdioPulmonary bioImage Study) when interpreting postbronchodilator spirometry in a general population. Methods: SCAPIS reference values for postbronchodilator and prebronchodilator spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or postbronchodilator reference values, with respiratory burden in the SCAPIS general population (28,851 individuals). Measurements and Main Results: Bronchodilation resulted in higher predicted medians and lower limits of normal (LLNs) for FEV1/FVC ratios. The prevalence of postbronchodilator FEV1/FVC ratio lower than the prebronchodilator LLN was 4.8%, and that of postbronchodilator FEV1/FVC lower than the postbronchodilator LLN was 9.9%, for the general population. An additional 5.1% were identified as having an abnormal postbronchodilator FEV1/FVC ratio, and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%; P < 0.001), and self-reported physician-diagnosed chronic obstructive pulmonary disease (2.8% vs. 0.5%, P < 0.001) than subjects with a postbronchodilator FEV1/FVC ratio greater than the LLN for both pre- and postbronchodilation. Conclusions: Pre- and postbronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of postbronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using postbronchodilator reference values when interpreting postbronchodilator spirometry might enable the identification of individuals with mild disease and be clinically relevant.

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