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Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers : a cross-sectional study

Toren, Kjell ; Schiöler, Linus ; Lindberg, Anne ; Andersson, Anders ; Behndig, Annelie F. ; Bergström, Göran ; Blomberg, Anders ; Caidahl, Kenneth ; Engvall, Jan and Eriksson, Maria , et al. (2020) In BMJ Open Respiratory Research 7(1).
Abstract

BACKGROUND: The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. METHODS: In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and... (More)

BACKGROUND: The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. METHODS: In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated their z-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI5 and increasing percentiles up to GLI25. We analysed the associations between different strata of percentiles and prevalence of any respiratory symptom using multivariable logistic regression for estimation of OR. RESULTS: Among all subjects, regardless of smoking habits, the odds of any respiratory symptom were elevated up to the GLI15-20 strata. Among never-smokers, the odds of any respiratory symptom were elevated at GLI<5 (OR 3.57, 95% CI 2.43 to 5.23) and at GLI5-10 (OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds of any respiratory symptom were elevated from GLI<5 (OR 4.64, 95% CI 3.79 to 5.68) up to GLI≥25 (OR 1.33, 95% CI 1.00 to 1.75). CONCLUSIONS: The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
clinical epidemiology
in
BMJ Open Respiratory Research
volume
7
issue
1
article number
e000600
publisher
BMJ Publishing Group
external identifiers
  • scopus:85089170065
  • pmid:32759170
ISSN
2052-4439
DOI
10.1136/bmjresp-2020-000600
language
English
LU publication?
yes
id
afbef15e-6612-4b13-9852-f53a777cb88b
date added to LUP
2020-08-18 10:20:34
date last changed
2024-06-12 20:15:18
@article{afbef15e-6612-4b13-9852-f53a777cb88b,
  abstract     = {{<p>BACKGROUND: The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. METHODS: In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated their z-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI5 and increasing percentiles up to GLI25. We analysed the associations between different strata of percentiles and prevalence of any respiratory symptom using multivariable logistic regression for estimation of OR. RESULTS: Among all subjects, regardless of smoking habits, the odds of any respiratory symptom were elevated up to the GLI15-20 strata. Among never-smokers, the odds of any respiratory symptom were elevated at GLI&lt;5 (OR 3.57, 95% CI 2.43 to 5.23) and at GLI5-10 (OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds of any respiratory symptom were elevated from GLI&lt;5 (OR 4.64, 95% CI 3.79 to 5.68) up to GLI≥25 (OR 1.33, 95% CI 1.00 to 1.75). CONCLUSIONS: The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.</p>}},
  author       = {{Toren, Kjell and Schiöler, Linus and Lindberg, Anne and Andersson, Anders and Behndig, Annelie F. and Bergström, Göran and Blomberg, Anders and Caidahl, Kenneth and Engvall, Jan and Eriksson, Maria and Hamrefors, Viktor and Janson, Christer and Kylhammar, David and Lindberg, Eva and Lindén, Anders and Malinovschi, Andrei and Persson, Hans Lennart and Sandelin, Martin and Eriksson Ström, Jonas and Tanash, Hanan A. and Vikgren, Jenny and Östgren, Carl Johan and Wollmer, Per and Sköld, C. Magnus}},
  issn         = {{2052-4439}},
  keywords     = {{clinical epidemiology}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open Respiratory Research}},
  title        = {{Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers : a cross-sectional study}},
  url          = {{http://dx.doi.org/10.1136/bmjresp-2020-000600}},
  doi          = {{10.1136/bmjresp-2020-000600}},
  volume       = {{7}},
  year         = {{2020}},
}