{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T20:45:10Z","timestamp":1775508310650,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,4,16]],"date-time":"2015-04-16T00:00:00Z","timestamp":1429142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"AstraZeneca research grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>The definition of chronic obstructive pulmonary disease (<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>) based on a fixed forced expiratory volume in 1\u2009s (FEV<jats:sub>1<\/jats:sub>)\/forced vital capacity (FVC) ratio or on the lower limits of<jats:styled-content style=\"fixed-case\">FEV<jats:sub>1<\/jats:sub><\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">FVC<\/jats:styled-content>of a healthy reference population is the subject of continuous debate. We explored whether dynamics of forced expiratory flow decline on spirometry can identify subjects with and without<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>when the two key diagnostic criteria are discordant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four hundred twenty\u2010three individuals with a history of \u226515 pack\u2010years smoking had pulmonary function measurements conducted. A second\u2010order input\u2013output model was used to describe the dynamics of the forced expiration. The capability of the model parameters to predict presence of disease was explored with a support vector machine classifier. In the discordant individuals, newly classified subjects were validated by other pulmonary function tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the non\u2010discordant subjects (<jats:italic>n<\/jats:italic>\u2009=\u2009370), the second\u2010order model was able to confirm a diagnosis of<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>in 95% of subjects (<jats:italic>n<\/jats:italic>\u2009=\u2009351). In the discordant individuals (<jats:italic>n<\/jats:italic>\u2009=\u200953), the classification by dynamic flow analysis found 28 patients to be healthy whereas 25 patients were still classified as<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>. Hyperinflation, increased airways resistance and reduced dynamic volumes were observed in the newly identified<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>group of discordant subjects. When using non\u2010spirometry\u2010based pulmonary function criteria as a standard for correct diagnoses in the individual discordant subjects, the model allocated 68% (<jats:italic>n<\/jats:italic>\u2009=\u200936) of the discordant to a correct diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Expiratory flow dynamics can detect airflow limitation and indicate the presence of<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>. In discordant subjects, our methodology allows a better identification of subjects with or without characteristics of<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12540","type":"journal-article","created":{"date-parts":[[2015,4,16]],"date-time":"2015-04-16T10:18:09Z","timestamp":1429179489000},"page":"925-931","source":"Crossref","is-referenced-by-count":11,"title":["Using dynamics of forced expiration to identify<scp>COPD<\/scp>where conventional criteria for the<scp>FEV<sub>1<\/sub><\/scp>\/<scp>FVC<\/scp>ratio do not match"],"prefix":"10.1111","volume":"20","author":[{"given":"Marko","family":"Topalovic","sequence":"first","affiliation":[{"name":"Respiratory Medicine University Hospital Leuven Department of Clinical and Experimental Medicine Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Exadaktylos","sequence":"additional","affiliation":[{"name":"Division Measure, Model and Manage Bioresponses (M3\u2010BIORES), Department of Biosystems Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Decramer","sequence":"additional","affiliation":[{"name":"Respiratory Medicine University Hospital Leuven Department of Clinical and Experimental Medicine Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Berckmans","sequence":"additional","affiliation":[{"name":"Division Measure, Model and Manage Bioresponses (M3\u2010BIORES), Department of Biosystems Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Troosters","sequence":"additional","affiliation":[{"name":"Respiratory Medicine University Hospital Leuven Department of Clinical and Experimental Medicine Catholic University of Leuven Leuven Belgium"},{"name":"Department of Rehabilitation Sciences Faculty of Kinesiology and Rehabilitation Sciences Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wim","family":"Janssens","sequence":"additional","affiliation":[{"name":"Respiratory Medicine University Hospital Leuven Department of Clinical and Experimental Medicine Catholic University of Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,4,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200703-456SO"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200804-035QC"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61380-4"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)07492-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61377-4"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60968-9"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201204-0596PP"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035205"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00103309"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00154307"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00135110"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2736"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-1349"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.1.200"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-1721"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00164608"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9712108"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00128113"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-014-1202-6"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200909-1364OC"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-14-131"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"issue":"3","key":"e_1_2_7_24_1","first-page":"5","article-title":"Lung volumes and forced ventilatory flows. 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