Defining chronic obstructive pulmonary disease in older persons

Objective: To develop a more age-appropriate spirometric definition of chronic obstructive pulmonary disease (COPD) among older persons. Methods: 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 1 s 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). Results: 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 doubted (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). Conclusion: 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. Published by Elsevier Ltd.