ArticleAnnals of family medicine
Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
51 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Incidence and Risk Factors for Progression from Pre-COPD to COPD: A Systematic Review and Meta‑analysis.International journal of chronic obstructive pulmonary disease · 2026Pooled it
- Pooled it
- Assessment of comorbidities and prognosis in patients with COPD diagnosed with the fixed ratio and the lower limit of normal: a systematic review and meta-analysis.Respiratory research · 2020Pooled it
- Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies.BMJ open · 2019Pooled it
- Clinical characteristics of patients newly diagnosed with COPD by the fixed ratio and lower limit of normal criteria: a cross-sectional analysis of the TargetCOPD trial.International journal of chronic obstructive pulmonary disease · 2018Trial
- Joint statement from GOLD/GLI regarding the use of spirometry to define airflow obstruction and diagnose COPD.The European respiratory journal · 2026Article
- Defining obstruction in COPD: do fixed ratio and lower limit of normal criteria reflect different clinical characteristics? findings from a Greek cross-sectional study (EMENO).BMC pulmonary medicine · 2026Article
- Forced vital capacity of healthy Iranian adults in Tehran.BMC pulmonary medicine · 2025Article
- Oscillometry-defined Small Airway Dysfunction in Tobacco-exposed Adults with Impaired or Preserved Airflow.American journal of respiratory and critical care medicine · 2025Article
- Risk of All-Cause Mortality in Mild Chronic Obstructive Pulmonary Disease: Evidence From the NHANES III and 2007-2012.International journal of chronic obstructive pulmonary disease · 2025Article
- Symptoms of COPD in the absence of airflow obstruction are more indicative of pre-COPD than overdiagnosis.ERJ open research · 2024Article
- Development of a web application to evaluate spirometric curve and clinical variables to support COPD diagnosis in primary care.Biomedica : revista del Instituto Nacional de Salud · 2024Article
- Do American Thoracic Society and European Respiratory Society Journals Have a Role in Promoting Official American Thoracic Society and European Respiratory Society Standards?Annals of the American Thoracic Society · 2023Article
- Understanding COPD Etiology, Pathophysiology, and Definition.Respiratory care · 2023Article
- Prevalence of obstructive lung patterns and actual spirometric result at different workplaces in Ethiopia: A systematic review and meta-analysis.Health science reports · 2023Article
- Recent Prevalence of and Factors Associated With Chronic Obstructive Pulmonary Disease in a Rapidly Aging Society: Korea National Health and Nutrition Examination Survey 2015-2019.Journal of Korean medical science · 2023Observational
- Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.The European respiratory journal · 2023Article
- Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.American journal of respiratory and critical care medicine · 2023Article
- The Challenges of Spirometric Diagnosis of COPD.Canadian respiratory journal · 2023Review
- Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial.International journal of chronic obstructive pulmonary disease · 2023Article
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Authors and funding
8 authors.
Funding
Abstract
purposeThe way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC): the fixed ratio and the lower limit of normal.
methodsWe analyzed data from the cross-sectional phase of the population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patient-reported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations.
resultsWe analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV1, defined as one less than 80% of the predicted value.
conclusionsOur results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV1/FVC (according to fixed ratio and/or lower limit of normal) and a low FEV1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.
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