Post-bronchodilator spirometry reference values in adults and implications for disease management

Am J Respir Crit Care Med. 2006 Jun 15;173(12):1316-25. doi: 10.1164/rccm.200601-023OC. Epub 2006 Mar 23.


Rationale: International guidelines promote the use of post-bronchodilator spirometry values in the definition and severity classification of chronic obstructive pulmonary disease. However, post-bronchodilator reference values have not yet been developed.

Objectives: To derive reference values for post-bronchodilator forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, and to compare these reference values with locally derived and existing pre-bronchodilator reference values.

Methods: Based on a random sample of a general adult population, 2,235 subjects (70% of invited subjects) performed spirometry with reversibility testing. A reference population of healthy never-smokers constituted 23% of the study population (n=515). Reference values for median and lower-limit-of-normal pre- and post-bronchodilator lung function and bronchodilator response were modeled using quantile regression analyses.

Main results: The reference population had equal proportions of men and women in the age range 26-82 yr. Both FEV1 and FVC decreased with age and increased with height. FEV1/FVC decreased with age, although this trend was not statistically significant for men after bronchodilatation. Linear models gave the best overall fit. Lower-limit-of-normal post-bronchodilator FEV1/FVC exceeded 0.7 for both sexes. Post-bronchodilator prediction equations gave higher predicted FEV1 and FEV1/FVC than both locally derived and existing pre-bronchodilator equations. The bronchodilator response decreased with age.

Conclusions: The present study is the first to develop reference values for post-bronchodilator lung function. Post-bronchodilator prediction equations can facilitate better management of patients with chronic obstructive pulmonary disease by avoiding falsely high FEV1% predicted with a subsequent underestimation of disease severity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Albuterol
  • Body Height
  • Bronchodilator Agents*
  • Cohort Studies
  • Female
  • Forced Expiratory Volume / drug effects
  • Forced Expiratory Volume / physiology
  • Forecasting
  • Functional Residual Capacity / drug effects
  • Functional Residual Capacity / physiology
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / classification*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Reference Values
  • Sex Factors
  • Spirometry / standards*


  • Bronchodilator Agents
  • Albuterol