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        "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 &#40;FEV<span class="elsevierStyleInf">1</span>&#41; expressed as a percentage of the predicted value after application of a bronchodilator&#46; This study aims to determine postbronchodilator spirometry reference values&#46;</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 &#40;S&#227;o Paulo&#44; Mexico City&#44; Montevideo&#44; Santiago&#44; and Caracas&#41;&#46; Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 &#956;g of salbutamol&#46; Multiple linear regression equations were fitted for the postbronchodilator spirometric values&#8211;FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in 6 seconds &#40;FEV<span class="elsevierStyleInf">6</span>&#41;&#44; peak expiratory flow rate&#44; forced vital capacity &#40;FVC&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FEV<span class="elsevierStyleInf">6</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and forced expiratory flow between 25&#37; and 75&#37; of vital capacity &#40;FEF<span class="elsevierStyleInf">25-75</span>&#41;&#46; These were adjusted for sex&#44; age&#44; and height in 887 asymptomatic subjects with no history of lung disease&#46;</p> <span class="elsevierStyleSectionTitle">RESULTS</span><p class="elsevierStyleSimplePara elsevierViewall">The postbronchodilator reference values for FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; and FEV<span class="elsevierStyleInf">1</span>&#47;FEV<span class="elsevierStyleInf">6</span> were on average 3&#37; higher than those obtained before bronchodilation&#46; This apparently small difference caused an upward shift in the 5th percentile &#40;lower limit of normal&#41; of the predicted values&#46; When prebronchodilation instead of postbronchodilation reference values were used&#44; 3&#46;2&#37; of the results for airflow obstruction in our population of over-40-year-olds were false negatives&#46;</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&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La clasificaci&#243;n de la gravedad de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; se basa&#44; de acuerdo con la iniciativa GOLD&#44; en el volumen espiratorio forzado en el primer segundo &#40;FEV<span class="elsevierStyleInf">1</span>&#41; despu&#233;s de usar broncodilatador&#44; expresado como porcentaje del esperado&#46; El prop&#243;sito de este trabajo ha sido determinar los valores de referencia para la espirometr&#237;a despu&#233;s de la administraci&#243;n de broncodilatador&#46;</p> <span class="elsevierStyleSectionTitle">SUJETOS Y M&#201;TODOS</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un muestreo por conglomerados de sujetos de 40 a&#241;os o m&#225;s&#44; representativos de las zonas metropolitanas de S&#227;o Paulo&#44; Ciudad de M&#233;xico&#44; Montevideo&#44; Santiago y Caracas&#46; Se realiz&#243; una espirometr&#237;a a 5&#46;183 sujetos de acuerdo con las recomendaciones de la American Thoracic Society&#44; antes y despu&#233;s de la inhalaci&#243;n de 200 &#956;g de salbutamol&#46; Se efectuaron regresiones lineales m&#250;ltiples para los valores espirom&#233;tricos &#8211;FEV<span class="elsevierStyleInf">1</span>&#44; volumen espiratorio forzado en 6 s &#40;FEV<span class="elsevierStyleInf">6</span>&#41;&#44; &#237;ndice de flujo espiratorio m&#225;ximo&#44; capacidad vital forzada &#40;FVC&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FEV<span class="elsevierStyleInf">6</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC y flujo mesoespiratorio forzado&#8211; despu&#233;s del uso del broncodilatador&#44; ajustando por sexo&#44; edad y altura&#44; en 887 sujetos sin evidencia de enfermedad pulmonar previa&#46;</p> <span class="elsevierStyleSectionTitle">RESULTADOS</span><p class="elsevierStyleSimplePara elsevierViewall">Los valores de referencia tras broncodilatador para FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC y FEV<span class="elsevierStyleInf">1</span>&#47;FEV<span class="elsevierStyleInf">6</span> fueron en promedio un 3&#37; mayores que los obtenidos con la espirometr&#237;a realizada antes de la inhalaci&#243;n del broncodilatador&#46; Esta diferencia&#44; que parece peque&#241;a&#44; causa un desplazamiento hacia arriba en el percentil 5 &#40;l&#237;mite inferior de la normalidad&#41; de los valores esperados&#46; Si se utiliza el valor de referencia prebroncodilatador&#44; en lugar del posbroncodilatador&#44; se genera un 3&#44;2&#37; de falsos negativos para obstrucci&#243;n al flujo a&#233;reo en el total de la poblaci&#243;n de 40 o m&#225;s a&#241;os de edad&#46;</p> <span class="elsevierStyleSectionTitle">CONCLUSIONES</span><p class="elsevierStyleSimplePara elsevierViewall">Los valores de referencia indicados son m&#225;s apropiados para espirometr&#237;as realizadas despu&#233;s de la inhalaci&#243;n del broncodilatador y permiten minimizar los errores de clasificaci&#243;n&#46;</p>"
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Vol. 43. Issue 10.
Pages 530-534 (January 2007)
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Vol. 43. Issue 10.
Pages 530-534 (January 2007)
Original Articles
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Spirometry Reference Values After Inhalation of 200 μg of Salbutamol
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Rogelio Pérez-Padillaa,
Corresponding author
perezpad@servidor.unam.mx

Correspondence: Dr. R. Pérez-Padilla. Instituto Nacional de Enfermedades Respiratorias. Tlalpan, 4502. 14080 Mexico City, Mexico
, 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 *
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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Article information
Objective

The criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV1) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values.

SUBJECTS AND METHODS

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–FEV1, forced expiratory volume in 6 seconds (FEV6), peak expiratory flow rate, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease.

RESULTS

The postbronchodilator reference values for FEV1, FEV1/FVC, and FEV1/FEV6 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.

CONCLUSIONS

The reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.

Key words:
Chronic obstructive pulmonary disease (COPD)
Bronchodilator response
Reference values
Spirometry
Cross- sectional study
Latin America
PLATINO
Objetivo

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 (FEV1) 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.

SUJETOS Y MÉTODOS

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 –FEV1, volumen espiratorio forzado en 6 s (FEV6), índice de flujo espiratorio máximo, capacidad vital forzada (FVC), FEV1/FEV6, FEV1/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.

RESULTADOS

Los valores de referencia tras broncodilatador para FEV1, FEV1/FVC y FEV1/FEV6 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.

CONCLUSIONES

Los valores de referencia indicados son más apropiados para espirometrías realizadas después de la inhalación del broncodilatador y permiten minimizar los errores de clasificación.

Palabras clave:
EPOC
Respuesta al broncodilatador
Valores de referencia
Espirometría
Estudio transversal
Latinoamérica
PLATINO
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The remaining members of the PLATINO group are listed at the end of the article.

This study was financed by a Boehringer-Ingelheim research grant. The company played no role in the data analysis or preparation of the manuscript.

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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