{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T04:39:27Z","timestamp":1773722367684,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,1,30]],"date-time":"2015-01-30T00:00:00Z","timestamp":1422576000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Yale Claude D. Pepper Older Americans Independence Center","award":["P30AG021342"],"award-info":[{"award-number":["P30AG021342"]}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["K07AG043587"],"award-info":[{"award-number":["K07AG043587"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]},{"name":"START@Yale Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To evaluate whether a novel definition of spirometric respiratory impairment from the Global Lung Initiative (\n                      <jats:styled-content style=\"fixed-case\">GLI<\/jats:styled-content>\n                      ) is strongly associated with respiratory symptoms and, in turn, frequently establishes symptomatic respiratory disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Third National Health and Nutrition Examination Survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Community\u2010dwelling individuals aged 40 to 80 (N\u00a0=\u00a07,115).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      GLI\u2010defined spirometric respiratory impairment (airflow obstruction and restrictive pattern), dyspnea on exertion (\n                      <jats:styled-content style=\"fixed-case\">DOE<\/jats:styled-content>\n                      ), chronic bronchitis (\n                      <jats:styled-content style=\"fixed-case\">CB<\/jats:styled-content>\n                      ), and wheezing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Prevalence rates were 12.7% for airflow obstruction, 6.2% for restrictive pattern, 28.6% for DOE, 12.6% for CB, and 12.9% for wheezing. Airflow obstruction was associated with DOE (adjusted odds ratio (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      )\u00a0=\u00a01.69, 95% confidence interval (CI)\u00a0=\u00a01.42\u20132.02), CB (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      \u00a0=\u00a01.92, 95% CI\u00a0=\u00a01.62\u20132.29), and wheezing (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      \u00a0=\u00a02.50, 95% CI\u00a0=\u00a02.08\u20133.00), and restrictive pattern was associated with DOE (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      \u00a0=\u00a01.75, 95% CI\u00a0=\u00a01.36\u20132.25), CB (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      \u00a0=\u00a01.39, 95% CI\u00a0=\u00a01.08\u20131.78), and wheezing (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      \u00a0=\u00a01.53, 95% CI\u00a0=\u00a01.15\u20132.04). Nonetheless, among participants who had airflow obstruction and restrictive pattern, only a minority had DOE (38.6% and 45.5%), CB (23.3% and 15.9%), and wheezing (24.4% and 19.1%), yielding a positive predictive value (PPV) of only 53% for any respiratory symptom in the setting of any spirometric respiratory impairment. In addition, most participants who had DOE (73.0%), CB (67.8%), and wheezing (66.8%) did not have airflow obstruction or restrictive pattern, yielding a PPV of only 26% for any spirometric respiratory impairment in the setting of any respiratory symptom. The results differed only modestly when stratified according to age (40\u201364 vs 65\u201380).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      GLI\u2010defined spirometric respiratory impairment increased the likelihood of respiratory symptoms but was nonetheless a poor predictor of respiratory symptoms. Similarly, respiratory symptoms were poor predictors of\n                      <jats:styled-content style=\"fixed-case\">GLI<\/jats:styled-content>\n                      \u2010defined spirometric respiratory impairment. Hence, a comprehensive assessment is needed when evaluating respiratory symptoms, even in the presence of spirometric respiratory impairment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.13242","type":"journal-article","created":{"date-parts":[[2015,1,31]],"date-time":"2015-01-31T00:13:28Z","timestamp":1422663208000},"page":"251-257","source":"Crossref","is-referenced-by-count":33,"title":["Respiratory Symptoms, Spirometric Respiratory Impairment, and Respiratory Disease in Middle\u2010Aged and Older Persons"],"prefix":"10.1111","volume":"63","author":[{"given":"Brian S.","family":"Marcus","sequence":"first","affiliation":[{"name":"School of Medicine Yale University New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail","family":"McAvay","sequence":"additional","affiliation":[{"name":"School of Medicine Yale University New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Gill","sequence":"additional","affiliation":[{"name":"School of Medicine Yale University New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos A.","family":"Vaz Fragoso","sequence":"additional","affiliation":[{"name":"School of Medicine Yale University New Haven Connecticut"},{"name":"Department of Veterans Affairs Clinical Epidemiology Research Center West Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,1,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1990.00040031685016"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2042ST"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2006.00564.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a062366"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmi064"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042741"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.106.3.827"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.2_Supplement.43S"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00003609"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00141611"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00054103a"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7083.792"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glr198"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201204-0596PP"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2009-040GL"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035205"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200708-1248OC"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00080312"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.6.1939"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1007285"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.43.4.265"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.12422"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.6.716"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2012.07.016"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00128711"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200909-1366OC"},{"key":"e_1_2_6_28_1","unstructured":"U.S. Department of Health and Human Services.National Center for Health Statistics. 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