Respiratory Symptoms, Spirometric Respiratory Impairment, and Respiratory Disease in Middle-Aged and Older Persons

• Autores: Brian S. Marcus, Gail McAvay, Thomas M. Gill, Carlos A. Vaz Fragoso
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 63, Nº. 2, 2015, págs. 251-257
• Idioma: inglés
• Enlaces
  • Texto completo
• Resumen

  • 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.