Original Articles
Spirometry Reference Values After Inhalation of 200 μg of Salbutamol
Rogelio Pérez-Padillaa,
, Luis Torre Bouscouleta, Juan Carlos Vázquez-Garcíaa, Adriana Muiñob, María Márquezb, María Victorina Lópezb, María Montes de Ocac, Carlos Tálamoc, Gonzalo Valdiviad, Julio Pertuzed, José Jardime, Ana María B. Menezesf, on behalf of the PLATINO group *
Corresponding author
perezpad@servidor.unam.mx
Correspondence: Dr. R. Pérez-Padilla. Instituto Nacional de Enfermedades Respiratorias. Tlalpan, 4502. 14080 Mexico City, Mexico
Correspondence: Dr. R. Pérez-Padilla. Instituto Nacional de Enfermedades Respiratorias. Tlalpan, 4502. 14080 Mexico City, Mexico
a Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
b Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
c División Pulmonar, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
d Pontificia Universidad Católica de Chile, Santiago, Chile
e Universidad Federal de São Paulo, São Paulo, Brazil
f Universidad Federal de Pelotas, Pelotas, Brazil
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"apellidos" => "Menezes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] ] 12 => array:2 [ "colaborador" => "on behalf of the PLATINO group" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de la República, Montevideo, Uruguay" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "División Pulmonar, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Universidad Federal de São Paulo, São Paulo, Brazil" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 5 => array:3 [ "entidad" => "Universidad Federal de Pelotas, Pelotas, Brazil" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. R. Pérez-Padilla. Instituto Nacional de Enfermedades Respiratorias. Tlalpan, 4502. 14080 Mexico City, Mexico" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-09-03" "fechaAceptado" => "2006-09-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154612" "palabras" => array:7 [ 0 => "Chronic obstructive pulmonary disease (COPD)" 1 => "Bronchodilator response" 2 => "Reference values" 3 => "Spirometry" 4 => "Cross- sectional study" 5 => "Latin America" 6 => "PLATINO" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154611" "palabras" => array:7 [ 0 => "EPOC" 1 => "Respuesta al broncodilatador" 2 => "Valores de referencia" 3 => "Espirometría" 4 => "Estudio transversal" 5 => "Latinoamérica" 6 => "PLATINO" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV<span class="elsevierStyleInf">1</span>) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values.</p> <span class="elsevierStyleSectionTitle">SUBJECTS AND METHODS</span><p class="elsevierStyleSimplePara elsevierViewall">A cluster sample of subjects aged 40 years or over was chosen to be representative of the metropolitan areas of 5 Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, and Caracas). Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 μg of salbutamol. Multiple linear regression equations were fitted for the postbronchodilator spirometric values–FEV<span class="elsevierStyleInf">1</span>, forced expiratory volume in 6 seconds (FEV<span class="elsevierStyleInf">6</span>), peak expiratory flow rate, forced vital capacity (FVC), FEV<span class="elsevierStyleInf">1</span>/FEV<span class="elsevierStyleInf">6</span>, FEV<span class="elsevierStyleInf">1</span>/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF<span class="elsevierStyleInf">25-75</span>). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease.</p> <span class="elsevierStyleSectionTitle">RESULTS</span><p class="elsevierStyleSimplePara elsevierViewall">The postbronchodilator reference values for FEV<span class="elsevierStyleInf">1</span>, FEV<span class="elsevierStyleInf">1</span>/FVC, and FEV<span class="elsevierStyleInf">1</span>/FEV<span class="elsevierStyleInf">6</span> were on average 3% higher than those obtained before bronchodilation. This apparently small difference caused an upward shift in the 5th percentile (lower limit of normal) of the predicted values. When prebronchodilation instead of postbronchodilation reference values were used, 3.2% of the results for airflow obstruction in our population of over-40-year-olds were false negatives.</p> <span class="elsevierStyleSectionTitle">CONCLUSIONS</span><p class="elsevierStyleSimplePara elsevierViewall">The reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica (EPOC) se basa, de acuerdo con la iniciativa GOLD, en el volumen espiratorio forzado en el primer segundo (FEV<span class="elsevierStyleInf">1</span>) después de usar broncodilatador, expresado como porcentaje del esperado. El propósito de este trabajo ha sido determinar los valores de referencia para la espirometría después de la administración de broncodilatador.</p> <span class="elsevierStyleSectionTitle">SUJETOS Y MÉTODOS</span><p class="elsevierStyleSimplePara elsevierViewall">Se realizó un muestreo por conglomerados de sujetos de 40 años o más, representativos de las zonas metropolitanas de São Paulo, Ciudad de México, Montevideo, Santiago y Caracas. Se realizó una espirometría a 5.183 sujetos de acuerdo con las recomendaciones de la American Thoracic Society, antes y después de la inhalación de 200 μg de salbutamol. Se efectuaron regresiones lineales múltiples para los valores espirométricos –FEV<span class="elsevierStyleInf">1</span>, volumen espiratorio forzado en 6 s (FEV<span class="elsevierStyleInf">6</span>), índice de flujo espiratorio máximo, capacidad vital forzada (FVC), FEV<span class="elsevierStyleInf">1</span>/FEV<span class="elsevierStyleInf">6</span>, FEV<span class="elsevierStyleInf">1</span>/FVC y flujo mesoespiratorio forzado– después del uso del broncodilatador, ajustando por sexo, edad y altura, en 887 sujetos sin evidencia de enfermedad pulmonar previa.</p> <span class="elsevierStyleSectionTitle">RESULTADOS</span><p class="elsevierStyleSimplePara elsevierViewall">Los valores de referencia tras broncodilatador para FEV<span class="elsevierStyleInf">1</span>, FEV<span class="elsevierStyleInf">1</span>/FVC y FEV<span class="elsevierStyleInf">1</span>/FEV<span class="elsevierStyleInf">6</span> fueron en promedio un 3% mayores que los obtenidos con la espirometría realizada antes de la inhalación del broncodilatador. Esta diferencia, que parece pequeña, causa un desplazamiento hacia arriba en el percentil 5 (límite inferior de la normalidad) de los valores esperados. Si se utiliza el valor de referencia prebroncodilatador, en lugar del posbroncodilatador, se genera un 3,2% de falsos negativos para obstrucción al flujo aéreo en el total de la población de 40 o más años de edad.</p> <span class="elsevierStyleSectionTitle">CONCLUSIONES</span><p class="elsevierStyleSimplePara elsevierViewall">Los valores de referencia indicados son más apropiados para espirometrías realizadas después de la inhalación del broncodilatador y permiten minimizar los errores de clasificación.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">The remaining members of the PLATINO group are listed at the end of the article.</p>" ] 1 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was financed by a Boehringer-Ingelheim research grant. The company played no role in the data analysis or preparation of the manuscript.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "BR Celli" 1 => "W MacNee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2004" "volumen" => "23" "paginaInicial" => "932" "paginaFinal" => "946" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15219010" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 33 | 31 | 64 |
| 2024 September | 35 | 24 | 59 |
| 2024 August | 63 | 50 | 113 |
| 2024 July | 22 | 18 | 40 |
| 2024 June | 48 | 28 | 76 |
| 2024 May | 42 | 25 | 67 |
| 2024 April | 26 | 31 | 57 |
| 2024 March | 32 | 19 | 51 |
| 2024 February | 25 | 23 | 48 |
| 2023 March | 4 | 4 | 8 |
| 2023 February | 20 | 18 | 38 |
| 2023 January | 20 | 32 | 52 |
| 2022 December | 20 | 34 | 54 |
| 2022 November | 31 | 26 | 57 |
| 2022 October | 38 | 50 | 88 |
| 2022 September | 22 | 48 | 70 |
| 2022 August | 28 | 42 | 70 |
| 2022 July | 33 | 42 | 75 |
| 2022 June | 25 | 48 | 73 |
| 2022 May | 28 | 43 | 71 |
| 2022 April | 28 | 42 | 70 |
| 2022 March | 32 | 59 | 91 |
| 2022 February | 21 | 50 | 71 |
| 2022 January | 14 | 28 | 42 |
| 2021 December | 14 | 57 | 71 |
| 2021 November | 16 | 47 | 63 |
| 2021 October | 19 | 49 | 68 |
| 2021 September | 14 | 64 | 78 |
| 2021 August | 16 | 26 | 42 |
| 2021 July | 23 | 34 | 57 |
| 2021 June | 11 | 24 | 35 |
| 2021 May | 17 | 36 | 53 |
| 2021 April | 33 | 66 | 99 |
| 2021 March | 13 | 15 | 28 |
| 2021 February | 10 | 15 | 25 |
| 2021 January | 9 | 13 | 22 |
| 2020 December | 10 | 12 | 22 |
| 2020 November | 11 | 14 | 25 |
| 2020 October | 8 | 12 | 20 |
| 2020 September | 7 | 5 | 12 |
| 2020 August | 10 | 8 | 18 |
| 2020 July | 10 | 19 | 29 |
| 2020 June | 3 | 9 | 12 |
| 2020 May | 9 | 12 | 21 |
| 2020 April | 10 | 19 | 29 |
| 2020 March | 10 | 14 | 24 |
| 2020 February | 11 | 6 | 17 |
| 2020 January | 9 | 15 | 24 |
| 2019 December | 18 | 16 | 34 |
| 2019 November | 9 | 10 | 19 |
| 2019 October | 9 | 5 | 14 |
| 2019 September | 17 | 14 | 31 |
| 2019 August | 14 | 5 | 19 |
| 2019 July | 9 | 14 | 23 |
| 2019 June | 6 | 3 | 9 |
| 2019 May | 10 | 6 | 16 |
| 2019 April | 20 | 21 | 41 |
| 2019 March | 7 | 18 | 25 |
| 2019 February | 10 | 12 | 22 |
| 2019 January | 18 | 10 | 28 |
| 2018 December | 11 | 15 | 26 |
| 2018 November | 15 | 10 | 25 |
| 2018 October | 28 | 16 | 44 |
| 2018 September | 20 | 10 | 30 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 6 | 11 | 17 |
| 2018 March | 9 | 3 | 12 |
| 2018 February | 4 | 8 | 12 |
| 2018 January | 3 | 5 | 8 |
| 2017 December | 3 | 7 | 10 |
| 2017 November | 2 | 6 | 8 |
| 2017 October | 3 | 14 | 17 |
| 2017 September | 4 | 14 | 18 |
| 2017 August | 5 | 22 | 27 |
| 2017 July | 6 | 23 | 29 |
| 2017 June | 8 | 9 | 17 |
| 2017 May | 10 | 7 | 17 |
| 2017 April | 10 | 8 | 18 |
| 2017 March | 33 | 38 | 71 |
| 2017 February | 4 | 1 | 5 |
| 2017 January | 5 | 0 | 5 |
| 2016 December | 8 | 6 | 14 |
| 2016 November | 10 | 7 | 17 |
| 2016 October | 10 | 5 | 15 |
| 2016 September | 7 | 5 | 12 |
| 2016 August | 5 | 3 | 8 |
| 2016 July | 2 | 3 | 5 |
| 2016 April | 2 | 0 | 2 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 75 | 18 | 93 |
| 2015 September | 87 | 10 | 97 |
| 2015 August | 69 | 17 | 86 |
| 2015 July | 85 | 10 | 95 |
| 2015 June | 63 | 10 | 73 |
| 2015 May | 65 | 10 | 75 |
| 2015 April | 47 | 5 | 52 |
| 2015 March | 66 | 7 | 73 |
| 2015 February | 43 | 4 | 47 |
| 2015 January | 52 | 4 | 56 |
| 2014 December | 67 | 11 | 78 |
| 2014 November | 62 | 4 | 66 |
| 2014 October | 78 | 10 | 88 |
| 2014 September | 75 | 10 | 85 |
| 2014 August | 56 | 9 | 65 |
| 2014 July | 87 | 11 | 98 |
| 2014 June | 84 | 5 | 89 |
| 2014 May | 88 | 12 | 100 |
| 2014 April | 81 | 5 | 86 |
| 2014 March | 69 | 13 | 82 |
| 2014 February | 52 | 14 | 66 |
| 2014 January | 37 | 13 | 50 |
| 2013 December | 65 | 7 | 72 |
| 2013 November | 49 | 5 | 54 |
| 2013 October | 49 | 9 | 58 |
| 2013 September | 46 | 9 | 55 |
| 2013 August | 35 | 17 | 52 |
| 2013 July | 53 | 14 | 67 |
| 2013 June | 47 | 7 | 54 |
| 2013 May | 56 | 8 | 64 |
| 2013 April | 21 | 11 | 32 |
| 2013 March | 13 | 1 | 14 |
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