Abstract
BackgroundThere is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction. This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. There is, however, a lack of data from general populations analyzing whether RSP is a valid proxy for true pulmonary restriction. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry.MethodsThe data was from the Swedish CArdioPulmonary bioImage Study (SCAPIS Pilot), a general population-based study, comprising 983 adults aged 50–64. All subjects answered a respiratory questionnaire. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and after bronchodilation. TLC and residual volume (RV) was recorded using a body plethysmograph. All lung function values are generally expressed as percent predicted (% predicted) or in relation to lower limits of normal (LLN). True pulmonary restriction was defined as TLC < LLN5 defined as a Z score < − 1.645, i e the fifth percentile. RSP was defined as FEV1/FVC ≥ LLN and FVC < LLN after bronchodilation. Specificity, sensitivity, positive and negative likelihood ratios were calculated, and 95% confidence intervals (CIs) were calculated.ResultsThe prevalence of true pulmonary restriction was 5.4%, and the prevalence of RSP was 3.4%. The sensitivity of RSP to identify true pulmonary restriction was 0.34 (0.20–0.46), the corresponding specificity was 0.98 (0.97–0.99), and the positive likelihood ratio was 21.1 (11.3–39.4) and the negative likelihood ratio was 0.67 (0.55–0.81).ConclusionsRSP has low accuracy for identifying true pulmonary restriction. The results support previous observations that RSP is useful for ruling out true pulmonary restriction.
Highlights
IntroductionTrue pulmonary restriction is synonymous with reduced total lung capacity (TLC) and is associated with a number of pathological conditions that either take up space in the thoracic cavity or restricts movements of the thoracic cage or diaphragm – for example interstitial lung diseases, pleurisy, lung edema, kyphosis, neuromuscular weakness and severe obesity
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True pulmonary restriction is synonymous with reduced total lung capacity (TLC) and is associated with a number of pathological conditions that either take up space in the thoracic cavity or restricts movements of the thoracic cage or diaphragm – for example interstitial lung diseases, pleurisy, lung edema, kyphosis, neuromuscular weakness and severe obesity
Summary
True pulmonary restriction is synonymous with reduced total lung capacity (TLC) and is associated with a number of pathological conditions that either take up space in the thoracic cavity or restricts movements of the thoracic cage or diaphragm – for example interstitial lung diseases, pleurisy, lung edema, kyphosis, neuromuscular weakness and severe obesity. Torén et al BMC Pulmonary Medicine (2020) 20:55 require relatively sophisticated equipment such as a body plethysmograph, or helium or nitrogen gas analyzers [1, 2] These measurements are usually done in specialized lung function laboratories. The proxy restrictive spirometry pattern (RSP) has been defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥ 0.7 and FVC < 80% predicted [4]. There is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry
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