Comparison of spirometry criteria for the diagnosis of COPD: Results from the BOLD study

W. M. Vollmer, P. Gíslason, P. Burney, P. L. Enrigh, A. Gulsvik, A. Kocabas, A. S. Buist

Research output: Contribution to journalArticlepeer-review

207 Scopus citations


Published guidelines recommend spirometry to accurately diagnose chronic obstructive pulmonary disease (COPD). However, even spirometry-based COPD prevalence estimates can vary widely. We compared properties of several spirometry-based COPD definitions using data from the international Burden of Obstructive Lung Disease (BOLD)study. 14 sites recruited population-based samples of adults aged ≥40 yrs. Procedures included standardised questionnaires and post-bronchodilator spirometry. 10,001 individuals provided usable data. Use of the lower limit of normal (LLN) forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio reduced the age-related increases in COPD prevalence that are seen among healthy never-smokers when using the fixed ratio criterion (FEV1/FVC <0.7) recommended by the Global Initiative for Chronic Obstructive Lung Disease. The added requirement of an FEV1 either <80% predicted or below the LLN further reduced age-related increases and also led to the least site-to-site variability in prevalence estimates after adjusting for potential confounders. Use of the FEV1/FEV6 ratio in place of the FEV 1/FVC yielded similar prevalence estimates. Use of the FEV 1/FVC<LLN criterion instead of the FEV1/FVC <0.7 should minimise known age biases and better reflect clinically significant irreversible airflow limitation. Our study also supports the use of the FEV 1/FEV6 as a practical substitute for the FEV 1/FVC. Copyright

Original languageEnglish (US)
Pages (from-to)588-597
Number of pages10
JournalEuropean Respiratory Journal
Issue number3
StatePublished - Sep 2009


  • Adult
  • Chronic obstructive pulmonary disease
  • Epidemiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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