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Respiratory Symptoms, Spirometric Respiratory Impairment, and Respiratory Disease in Middle‐Aged and Older Persons
Author(s) -
Marcus Brian S.,
McAvay Gail,
Gill Thomas M.,
Vaz Fragoso Carlos A.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13242
Subject(s) - medicine , confidence interval , odds ratio , chronic bronchitis , national health and nutrition examination survey , respiratory disease , respiratory system , spirometry , bronchitis , asthma , physical therapy , pediatrics , lung , population , environmental health
Objectives To evaluate whether a novel definition of spirometric respiratory impairment from the Global Lung Initiative ( GLI ) is strongly associated with respiratory symptoms and, in turn, frequently establishes symptomatic respiratory disease. Design Cross‐sectional. Setting Third National Health and Nutrition Examination Survey. Participants Community‐dwelling individuals aged 40 to 80 (N = 7,115). Measurements GLI‐defined spirometric respiratory impairment (airflow obstruction and restrictive pattern), dyspnea on exertion ( DOE ), chronic bronchitis ( CB ), and wheezing. Results Prevalence rates were 12.7% for airflow obstruction, 6.2% for restrictive pattern, 28.6% for DOE, 12.6% for CB, and 12.9% for wheezing. Airflow obstruction was associated with DOE (adjusted odds ratio ( aOR ) = 1.69, 95% confidence interval (CI) = 1.42–2.02), CB ( aOR = 1.92, 95% CI = 1.62–2.29), and wheezing ( aOR = 2.50, 95% CI = 2.08–3.00), and restrictive pattern was associated with DOE ( aOR = 1.75, 95% CI = 1.36–2.25), CB ( aOR = 1.39, 95% CI = 1.08–1.78), and wheezing ( aOR = 1.53, 95% CI = 1.15–2.04). Nonetheless, among participants who had airflow obstruction and restrictive pattern, only a minority had DOE (38.6% and 45.5%), CB (23.3% and 15.9%), and wheezing (24.4% and 19.1%), yielding a positive predictive value (PPV) of only 53% for any respiratory symptom in the setting of any spirometric respiratory impairment. In addition, most participants who had DOE (73.0%), CB (67.8%), and wheezing (66.8%) did not have airflow obstruction or restrictive pattern, yielding a PPV of only 26% for any spirometric respiratory impairment in the setting of any respiratory symptom. The results differed only modestly when stratified according to age (40–64 vs 65–80). Conclusion GLI‐defined spirometric respiratory impairment increased the likelihood of respiratory symptoms but was nonetheless a poor predictor of respiratory symptoms. Similarly, respiratory symptoms were poor predictors of GLI ‐defined spirometric respiratory impairment. Hence, a comprehensive assessment is needed when evaluating respiratory symptoms, even in the presence of spirometric respiratory impairment.