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June 25, 2019

Accuracy of Airflow Obstruction Thresholds for Predicting COPD-Related Hospitalization and Mortality: Can Simple Diagnostic Thresholds Be Used for a Complex Disease?

Author Affiliations
  • 1Manchester Academic Health Science Centre, Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
  • 2North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • 3Institute of Public Health, Section of Epidemiology, Copenhagen University, Denmark
  • 4Medical Department, Respiratory Section, Herlev-Gentofte Hospital, Copenhagen University, Herlev, Denmark.
JAMA. 2019;321(24):2412-2413. doi:10.1001/jama.2019.6584

Diagnostic criteria for complex chronic diseases often include a threshold for a biomarker. In the case of chronic obstructive pulmonary disease (COPD) and hypertension, physiological biomarkers are applied. For COPD, the Global Initiative for Chronic Obstructive Lung Disease states that in a symptomatic individual with a relevant exposure (such as smoking), “the presence of a postbronchodilator FEV1:FVC of less than 0.70 confirms the presence of persistent airflow limitation and thus of COPD.”1 A decreased ratio between forced expiratory volume in the first second and forced vital capacity (FEV1:FVC), is an accepted measure of airflow limitation, but debate around the most accurate threshold level has been ongoing for decades.2,3