COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers.

The aim of this study was to establish which cut-off point for the forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) ratio ( i.e. fixed 0.70 or lower limit of normal (LLN) cut-off point) best predicts accelerated lung function decline and exacerbations in middle-aged smokers. We performed secondary analyses on the Lung Health Study dataset. 4045 smokers aged 35–60 years with mild-to-moderate obstructive pulmonary disease were subdivided into categories based on presence or absence of obstruction according to both FEV 1 /FVC cut-off points. Post-bronchodilator FEV 1 decline served as the primary outcome to compare subjects between the categories. 583 (14.4%) subjects were nonobstructed and 3230 (79.8%) subjects were obstructed according to both FEV 1 /FVC cut-off points. 173 (4.3%) subjects were obstructed according to the fixed cut-off point, but not according to the LLN cut-off point (“discordant” subjects). Mean±se post-bronchodilator FEV 1 decline was 41.8±2.0 mL·year −1 in nonobstructed subjects, 43.8±3.8 mL·year −1 in discordant subjects and 53.5±0.9 mL·year −1 in obstructed subjects (p Our study showed that FEV 1 decline in subjects deemed obstructed according to a fixed criterion (FEV 1 /FVC 1 decline in subjects designated as non-obstructed by both criteria. Sex and age should be taken into account when assessing airflow obstruction in middle-aged smokers.