• Ke Huang, Xueyan Han, Zhaoyang Pan, Jianying Xu, Jianping Zhao, Xiangyan Zhang, Yuanlin Song, Jian Kang, Pixin Ran, Yumin Zhou, Huahao Shen, Fuqiang Wen, Kewu Huang, Yahong Chen, Yanfei Guo, Guangliang Shan, Sinan Wu, Tianjia Guan, Ting Yang, and Chen Wang.
• China-Japan Friendship Hospital, 36635, Pulmonary and Critical Care Medicine, Beijing, China.
• Am. J. Respir. Crit. Care Med. 2024 Apr 30.

RationaleSpirometry reference equations that are derived from a large, nationally representative, general population are warranted in China and the impact of using pre- and post-BD spirometry reference values has yet to be assessed in Chinese populations.ObjectivesTo present both the pre-BD and post-BD spirometry reference values for Chinese adults using the China Pulmonary Health (CPH) study.MethodsA reference population of 17969 healthy, non-smoking participants in the CPH study was used to calculate the pre- and post-BD reference values for the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC. Both pre- and post-BD reference values were applied to the entire CPH population (50991 individuals) to illustrate the divergence between the use of references in determining the disease prevalence and severity grading.Measurements And Main ResultsThe prevalence of airflow limitation was 5.36% using pre-BD reference and 8.02% using the post-BD reference. Individuals who had post-BD FEV1/FVC below post-BD but higher than pre-BD reference values were found to have significantly higher rates of self-reported respiratory symptoms, and significantly lower values in spirometry indicators than those above post-BD reference values. An additional 3.51% of participants were identified as grade II-IV COPD using the post-BD FEV1 predicted values.ConclusionThis study generated and applied pre- and post-bronchodilator spirometry reference values in a nationally representative Chinese adult population. Post-BD reference values may serve as an additional criterion in identifying individuals at risk for obstructive pulmonary diseases, its diagnostic and prognostic values should be further investigated.

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