A Normal Forced Vital Capacity Does Not Reliably or Equitably Exclude Restriction.

Background: European Respiratory Society and American Thoracic Society (ERS/ATS) guidelines for pulmonary function test (PFT) interpretation recommend the use of a normal forced vital capacity (FVC) to exclude restriction. However, this recommendation is based upon a single study from 1999, which was limited to White patients, and used race-specific reference equations that are no longer recommended by ERS/ATS. We sought to reassess the support for this recommendation by calculating the negative predictive value (NPV) of a normal FVC in a diverse, multicenter cohort using race-neutral reference equations.

The Effect of a Post-Bronchodilator FEV/FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 second to forced vital capacity ratio (FEV/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.

Gender Differences in the Diagnosis of Chronic Obstructive Pulmonary Disease after Spirometry.

Background: Women are more likely than men to report delays in the diagnosis of chronic obstructive pulmonary disease (COPD), though the etiology of these delays is unknown. We sought to test whether delays in COPD diagnosis persist after the performance of spirometry.

Methods: We used the Optum Labs Data Warehouse to identify patients 18 years of age and older without a prior diagnosis of COPD, with a post-bronchodilator forced expiratory volume in 1 second (FEV) to forced vital capacity (FVC) ratio of less than 0.

Global, Race-Neutral Reference Equations and Pulmonary Function Test Interpretation.

Importance: Race and ethnicity are routinely used to inform pulmonary function test (PFT) interpretation. However, there is no biological justification for such use, and it may reinforce health disparities.

Objective: To compare the PFT interpretations produced with race-neutral and race-specific equations.