Application of the European Respiratory Society/American Thoracic Society Spirometry Standards and Race-Neutral Equations in the COPDGene Study.

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  • Additional Information
    • Source:
      Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
    • Publication Information:
      Publication: 2000- : New York, NY : American Thoracic Society
      Original Publication: New York, NY : American Lung Association, c1994-
    • Subject Terms:
      Pulmonary Disease, Chronic Obstructive*/physiopathology ; Pulmonary Disease, Chronic Obstructive*/genetics ; Pulmonary Disease, Chronic Obstructive*/diagnosis ; Spirometry*/methods ; Societies, Medical* ; Severity of Illness Index*; Humans ; Male ; Female ; Middle Aged ; Aged ; United States ; Forced Expiratory Volume ; Europe
    • Abstract:
      Rationale: For spirometry interpretation, the European Respiratory Society (ERS) and American Thoracic Society (ATS) recommend using z -scores, and the ATS has recommended using Global Lung Initiative (GLI) "Global" race-neutral reference equations. However, these recommendations have been variably implemented, and the impact has not been widely assessed in clinical or research settings. Objectives: To evaluate the ERS/ATS classification of airflow obstruction severity. Methods: In COPDGene (Genetic Epidemiology of COPD Study) ( N  = 10,108), airflow obstruction has been defined by an FEV 1 /FVC ratio <0.70, with spirometric severity graded from class 1 to class 4 based on race-specific percent predicted (pp) FEV 1 cutoff points as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We compared the GOLD approach, using National Health and Nutrition Examination Survey III race-specific equations, versus the application of GLI Global equations using the ERS/ATS definition of airflow obstruction as an FEV 1 /FVC ratio below the lower limit of normal and z-score-based FEV 1 cutoff points of -1.645, -2.5, and -4 ("zGLI Global"). We tested the four-tier severity scheme for association with chronic obstructive pulmonary disease outcomes. Measurements and Main Results: The lowest agreement between ERS/ATS with zGLI Global and the GOLD classification was observed in individuals with milder disease (56.9% and 42.5% in GOLD stages 1 and 2, respectively), and race was a major determinant of redistribution. After adjustment for relevant covariates, zGLI Global distinguished all-cause mortality risk between normal spirometry and the first grade of chronic obstructive pulmonary disease (hazard ratio, 1.23; 95% confidence interval, 1.04-1.44; P  = 0.014) and showed a linear increase in exacerbation rates with increasing disease severity in comparison with GOLD. Conclusions: The zGLI Global severity classification outperformed the GOLD criteria in the discrimination of survival, exacerbations, and imaging characteristics.
    • Comments:
      Comment in: Am J Respir Crit Care Med. 2024 Dec 1;210(11):1287-1289. doi: 10.1164/rccm.202404-0873ED. (PMID: 38820133)
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    • Grant Information:
      75N92023D00011 United States HL NHLBI NIH HHS; U01 HL089897 United States HL NHLBI NIH HHS; 75N92021D00011 United States HL NHLBI NIH HHS; U01 HL089856 United States HL NHLBI NIH HHS; 75N93023D00011 United States AI NIAID NIH HHS; 75N90023D00011 United States HL NHLBI NIH HHS; K23 HL153778 United States HL NHLBI NIH HHS
    • Contributed Indexing:
      Keywords: COPD; ethnicity; pulmonary function tests; survival analysis
    • Publication Date:
      Date Created: 20240412 Date Completed: 20241127 Latest Revision: 20241208
    • Publication Date:
      20241209
    • Accession Number:
      PMC11622435
    • Accession Number:
      10.1164/rccm.202311-2145OC
    • Accession Number:
      38607551