Combining small airway parameters with conventional parameters obtained during spirometry to diagnose airflow obstruction: A cross‐sectional study

Background and Objective The use of small airway parameters generated by spirometry, namely forced expiratory flow between 25% and 75% of forced vital capacity (FVC) (FEF 25%–75% ) and forced expiratory flow at 50% and 75% of FVC (FEF 50% and FEF 75% , respectively), is widely discussed. We evaluated the importance of these spirometric parameters in a large Chinese population. Methods We conducted a cross‐sectional observational study in which spirometry and bronchodilator responsiveness (BDR) data were collected in a healthcare centre from May 2021 to August 2022 and in a tertiary hospital from January 2017 to March 2022. Discordance was assessed between the classification of test results by the large airway parameters of forced expiratory volume in 1 second (FEV 1 ) and FEV 1 /FVC ratio and by the small airway parameters of FEF 25%–75% , FEF 75% and FEF 50% . The predictive power of Z‐scores of spirometric parameters for airflow limitation and BDR was assessed using receiver operating characteristic curves. Results Our study included 26,658 people. Among people with a normal FVC ( n = 14,688), 3.7%, 4.5% and 3.6% of cases exhibited normal FEV 1 /FVC ratio but impaired FEF 25%–75% , FEF 75% and FEF 50% , respectively, while 6.8%–7.0% of people exhibited normal FEV 1 but impaired FEF 25%–75% , FEF 75% and FEF 50% . Using the Z‐scores of combining both large and small airway parameters in spirometry showed the best area under the curve for predicting airflow limitation (0.90; 95% CI 0.87–0.94) and predicting BDR (0.72; 95% CI 0.71–0.73). Conclusion It is important to consider both large and small airway parameters in spirometry to avoid missing a diagnosis of airflow obstruction.