Improved spirometric detection of small airway narrowing: concavity in the expiratory flow volume curve in people aged over 40 years

David P. Johns, Aruneema Das, Brett G. Toelle, Michael J. Abramson, Guy B. Marks, Richard Wood-Baker, E. Haydn Walters

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
18 Downloads (Pure)


Background and objective: We have explored whether assessing the degree of concavity in the descending limb of the maximum expiratory flow–volume curve enhanced spirometric detection of early small airway disease.
Methods: We used spirometry records from 890 individuals aged ≥40 years (mean 59 years), recruited for the Burden of Obstructive Lung Disease Australia study. Central and peripheral concavity indices were developed from forced expired flows at 50% and 75% of the forced vital capacity, respectively, using an ideal line joining peak flow to zero flow.
Results: From the 268 subjects classified as normal never smokers, mean values for post-bronchodilator central concavity were 18.6% in males and 9.1% in females and those for peripheral concavity were 50.5% in males and 52.4% in females. There were moderately strong correlations between concavity and forced expired ratio (forced expiratory volume in 1 second/forced vital capacity) and mid-flow rate (forced expiratory flow between 25% and 75% of the FVC [FEF25%–75%]; r=-0.70 to -0.79). The additional number of individuals detected as abnormal using the concavity indices was substantial, especially compared with FEF25%–75%, where it was approximately doubled. Concavity was more specific for symptoms.
Conclusion: The inclusion of these concavity measures in the routine reports of spirometry would add information on small airway obstruction at no extra cost, time, or effort.
Original languageEnglish
Pages (from-to)3567-3577
Number of pages11
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Publication statusPublished - Dec 2017
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • early airway disease
  • airflow obstruction
  • COPD


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