Improved spirometric detection of small airway narrowing: concavity in the expiratory flow–volume curve in people aged over 40 years
Background and objective: We have explored whether assessing the degree of concavity in the descending limb of the maximum expiratory flow–volume curve enhanced spirometric detection of early small airway disease.
Methods: We used spirometry records from 890 individuals aged $40 years (mean 59 years), recruited for the Burden of Obstructive Lung Disease Australia study. Central and peripheral concavity indices were developed from forced expired flows at 50% and 75% of the forced vital capacity, respectively, using an ideal line joining peak flow to zero flow.
Results: From the 268 subjects classified as normal never smokers, mean values for postbronchodilator central concavity were 18.6% in males and 9.1% in females and those for peripheral concavity were 50.5% in males and 52.4% in females. There were moderately strong correlations between concavity and forced expired ratio (forced expiratory volume in 1 second/ forced vital capacity) and mid-flow rate (forced expiratory flow between 25% and 75% of the FVC [FEF25%–75%]; r=-0.70 to -0.79). The additional number of individuals detected as abnormal using the concavity indices was substantial, especially compared with FEF25%–75%M, where it was approximately doubled. Concavity was more specific for symptoms.
Conclusion: The inclusion of these concavity measures in the routine reports of spirometry would add information on small airway obstruction at no extra cost, time, or effort.
Publication titleCOPD: journal of chronic obstructive pulmonary disease
Department/SchoolTasmanian School of Medicine
PublisherTaylor & Francis Inc.
Place of publicationUnited States
Rights statementCopyright 2017 Johns et al. Licensed under Creative Commons Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0) https://creativecommons.org/licenses/by-nc/3.0/