title: Respiratory symptoms, spirometric respiratory impairment, and respiratory disease in middle-aged and older persons.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Third National Health and Nutrition Examination Survey.
  
  
  METHODS
  Community-dwelling individuals aged 40 to 80 (N = 7,115).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: School of Medicine, Yale University, New Haven, Connecticut.
authors: Brian S
authors: BS
authors: Marcus
authors: Gail
authors: G
authors: McAvay
authors: Thomas M
authors: TM
authors: Gill
authors: Carlos A
authors: CA
authors: Vaz Fragoso
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D029481:Bronchitis, Chronic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011237:Predictive Value of Tests; D015995:Prevalence; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology*; D013147:Spirometry; D014797:Vital Capacity
keywords: Z-scores; respiratory impairment; respiratory symptoms; spirometry
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