FEF Values in Patients with Normal Lung Function Can Predict the Development of Chronic Obstructive Pulmonary Disease

Purpose: The forced mid-expiratory flow (FEF) value is a potentially sensitive marker of obstructive peripheral airflow. We aimed to assess whether FEF can be an early predictor of chronic obstructive pulmonary disease (COPD).

Patients And Methods: Between July 1, 2007 and June 31, 2009, we identified 3624 patients who underwent a pulmonary function test (PFT) in Gangnam Severance Hospital. We selected 307 patients aged over 40 years without COPD who had normal PFT results at baseline and who had follow-up PFT records more than 1 year later. A FEF z-score less than -0.8435 was considered low. We defined COPD as a forced expiratory volume in one second/forced vital capacity value of less than 0.7 before July 31, 2019.

Results: Among 307 patients, 91 (29.6%) had low FEF at baseline. After 10 years, the incidence rate of COPD in the low FEF group was significantly higher than that in the normal FEF group (41.8% vs 7.4%; <0.001). The Cox proportional hazard model showed that age (hazard ratio [HR] 1.09; -value<0.001), smoking status (occasional smoker HR, 4.59; -value<0.001 and long-term smoker HR, 2.18; -value=0.023), and low FEF (HR, 3.31; -value<0.001) were predictive factors for the development of COPD.

Conclusion: The FEF value in patients with normal lung function is a useful predictor for the development of COPD. We should carefully monitor patients who present with low FEF values, even if they have normal lung function.