Misclassification based on spirometric findings may occur because: Content on this page requires a newer version of Adobe Flash Player.
An example (ref. 1). The mean FEV1 of a group of subjects is 3500 mL, SD 350 mL. The within subject variability (SD) in this example is either 105 or 140 mL. We classify an observation as ‘compatible with airway obstruction’ if it falls below the 2½ percentile. In a healthy population such a verdict is to be expected in 2½ per cent of the population. However, taking into account variability within individuals, so that actual observations may be above or below their representative mean level, then 26% and 35%, respectively, of ‘suspect values’ is not recognized.
In clinical practice the prevalence of disease is higher than in a normal population; in that case the proportion of observations ‘compatible with airway obstruction’ will be greater than in a normal population. Even in that case the ratio of within person and between person variability matters. The table below illustrates that if the prevalence rate of ‘suspect’ observations is 10% or 30%, 2.6 to 10.5% will be erroneously classified, respectively.
Ref. 1 - Example from: Quanjer PhH, Stocks J, Polgar G, Wise M, Karlberg J, Borsboom G. Compilation of reference values for lung function measurements. In: Standardization of lung function tests in paediatrics. Eur Respir J 1989; 2 suppl 4: 184s-261s.