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We assessed the prevalence of SAD in a European region with low air pollution levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>SAD was defined as a maximum mid-expiratory flow (MMEF) &lt;65% of predicted value (PV) or MMEF &lt;lower limit of normal (LLN) measured by spirometry in the Swiss PneumoLaus cohort. We performed bivariate and multivariable analysis with MMEF criteria, age, sex, body mass index, respiratory symptoms and smoking status. Mean PM<jats:sub>2.5<\/jats:sub>values were obtained from a Swiss national database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 3351 participants (97.6% Caucasian, 55.7% female sex, mean age 62.7\u2005years), we observed MMEF &lt;65% PV in 425 (12.7%) and MMEF &lt;LLN in 167 (5.0%) individuals. None of the participants had both MMEF &lt;LLN and \u226565% PV. MMEF &lt;65% PV and MMEF &lt;LLN were significantly associated with age, smoking status, cough, sputum and dyspnoea, whereas a positive association with MMEF &lt;65% PV was observed for individuals aged &gt;65\u2005years only. In an area where ambient PM<jats:sub>2.5<\/jats:sub>concentration was &lt;15\u2005\u00b5g\u00b7m<jats:sup>\u22123<\/jats:sup>during the observation period (2010 and 2020), \u226572% of participants with SAD were ever-smokers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The observed low prevalence of SAD of 5.0\u201312.7% depending on criteria employed may be related to lower PM<jats:sub>2.5<\/jats:sub>exposure. Smoking was the main factor associated with SAD in an area with low PM<jats:sub>2.5<\/jats:sub>exposure. Employing a MMEF threshold &lt;65% PV carries a risk of SAD overdiagnosis in elderly individuals.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00381-2023","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T14:20:46Z","timestamp":1689258046000},"page":"00381-2023","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of small airway dysfunction in the Swiss PneumoLaus 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