Defining chronic obstructive pulmonary disease in older persons - 07/08/11

Doi : 10.1016/j.rmed.2009.04.019 
Carlos A. Vaz Fragoso a, b, , John Concato a, b, Gail McAvay a, Peter H. Van Ness a, Carolyn L. Rochester a, b, H. Klar Yaggi a, b, Thomas M. Gill a
a Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, USA 
b Veterans Affairs (VA) Clinical Epidemiology Research Center, West Haven, CT, USA 

Corresponding author at: The Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue, Mailcode 151B, West Haven, CT, USA. Tel.: +1 203 688 9423; fax: +1 203 688 4209.



To develop a more age-appropriate spirometric definition of chronic obstructive pulmonary disease (COPD) among older persons.


Using data from the Third National Health and Nutrition Examination Survey (NHANES III), we developed a two-part spirometric definition of COPD in older persons, aged 65–80 years, that 1) determines a cut-point for the ratio of forced expiratory volume in 1s to forced vital capacity (FEV1/FVC) based on mortality risk; and 2) among persons below this critical FEV1/FVC threshold, determines cut-points for the FEV1, expressed as a standardized residual percentile (SR-tile) and based on the prevalence of respiratory symptoms and mortality risk. Measurements included spirometry, health questionnaires, and mortality (National Death Index).


There were 2480 older participants with a mean age of 71.7 years; 1372 (55.4%) had a smoking history, 1097 (44.2%) had respiratory symptoms and, over the course of 12-years, 868 (35.0%) had died. Among participants with an FEV1/FVC<.70 and FEV1<5th SR-tile, representing 7.7% of the cohort, the risk of death was doubled (adjusted hazard ratio, 2.01; 95% confidence interval [CI], 1.60–2.54). Among participants with an FEV1/FVC<.70 and FEV1<10th SR-tile, representing 13.4% of the cohort, the prevalence of respiratory symptoms was elevated (adjusted odds ratio, 2.44; CI, 1.79–3.33).


In a large, nationally representative sample of community-living older persons, defining COPD based on an FEV1/FVC<.70, with FEV1 cut-points at the 10th and 5th SR-tiles, identifies individuals with an increased prevalence of respiratory symptoms and an increased risk of death, respectively.

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Keywords : COPD, Spirometry, Respiratory symptoms, Mortality


© 2009  Publié par Elsevier Masson SAS.

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Vol 103 - N° 10

P. 1468-1476 - octobre 2009 Retour au numéro
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