The Association of Spirometric Small Airways Obstruction with Respiratory Symptoms, Cardiometabolic Diseases, and Quality of Life: Results from the Burden of Obstructive Lung Disease (BOLD) Study

Background: Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown.

Methods: Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV/FVC ≥ LLN).

Results: Almost a fifth of the participants had spirometric SAO (19% for FEF; 17% for FEV/FVC). Using FEF spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77-2.70), chronic cough (OR = 2.56, 95% CI 2.08-3.15), chronic phlegm (OR = 2.29, 95% CI 1.77-4.05), wheeze (OR = 2.87, 95% CI 2.50-3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11-1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV/FVC. Isolated spirometric SAO (10% for FEF; 6% for FEV/FVC), was also associated with respiratory symptoms and cardiovascular disease.

Conclusion: Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF and FEV/FVC, in addition to traditional spirometry parameters.