Interpreting periodic lung function tests in individuals: the relationship between 1- to 5-year and long-term FEV1 changes

Chest. 2006 Aug;130(2):493-9. doi: 10.1378/chest.130.2.493.


Study objective: Spirometry is performed to monitor lung health, but variability between tests can hinder recognition of excessive FEV(1) declines. We sought to describe the relationship between FEV(1) changes over 1 to 5 years and FEV(1) declines over longer terms, using 21,821 test results from 1,884 workers who participated in an annual health monitoring program at a chemical plant between 1973 and 2003.

Methods: Test results from workers with five or more valid results over > or = 10 years were included in our analysis (mean initial worker age, 35 years; range, 18 to 62 years; 91% male; 35% current smokers and 41% nonsmokers). For each worker, long-term FEV(1) slopes (milliliters per year) were calculated by simple linear regression using all available results and compared to changes in FEV(1) between two tests over 1 to 5 years, expressed in both milliliters and percentage of initial value.

Results: Long-term (mean, 18 years; range, 10 to 30 years) slopes averaged - 29.1 mL/yr (- 27, - 29, and - 37 mL/yr for male never-smokers, former smokers, and current smokers, and - 20, - 26, and - 27 mL/yr for female never-smokers, former smokers, and current smokers, respectively). Excessive short-term and long-term declines were defined by lower fifth percentile values. Individuals with abnormal short-term declines were found to be 3 to 18 times more likely to ultimately show excessive long-term declines; with the strength of the association increasing with the length of the short-term testing interval. Better test operating characteristics resulted if abnormal short-term FEV(1) change was based on percentage change (ie, percentage per year) rather than absolute change (ie, milliliters per year).

Conclusions: Our findings provide guidance for interpreting periodic spirometry results from individuals exposed to respiratory hazards.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / physiology*
  • Humans
  • Lung Diseases / diagnosis*
  • Lung Diseases / physiopathology
  • Male
  • Middle Aged
  • Occupational Diseases / diagnosis*
  • Occupational Diseases / physiopathology
  • Occupational Exposure / adverse effects
  • Reproducibility of Results
  • Spirometry
  • Time Factors