Definition of COPD: based on evidence or opinion?

To the Editors: In 1986, the American Thoracic Society (ATS) first suggested a fixed ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) <0.75 to define airflow obstruction 1. Subsequent ATS documents published in 1991 2 and 1995 3 generically defined airflow obstruction as a reduction of FEV1/FVC, without recommending any numerical cut-off point. By contrast, the European Respiratory Society (ERS) guidelines 4 suggested the diagnosis of airflow obstruction be based on a ratio of FEV1 to slow vital capacity (VC) <88 and <89% of predicted in males and females, respectively. These values were not arbitrarily chosen as they roughly correspond to the lower 95th percentiles of frequency distributions of a healthy population. More importantly, they are consistent with the well-known decrease of lung elastic recoil and, by inference, of forced expiratory flow with ageing. In 2001, the Global Initiative for …