Table 2.
Criteria for Assessing Clinical, Occupational, and Financial Outcomes.*
| Outcome | Spirometric Criteria† | Age Criteria | Other Criteria | Source |
|---|---|---|---|---|
| Ventilatory impairment | 6–79 yr | None | ERS-ATS (2021)2 | |
| Obstructive | FEV1:FVC <LLN | |||
| Nonobstructive | FEV1 or FVC <LLN and FEV1:FVC >LLN | |||
| COPD severity | 6–79 yr | None | GOLD (2023)3 | |
| Grade 1 (least severe) | FEV1:FVC <0.70 and FEV1 ≥80% of predicted | |||
| Grade 2 | FEV1:FVC <0.70 and FEV1 50–79% of predicted | |||
| Grade 3 | FEV1:FVC <0.70 and FEV1 30–49% of predicted | |||
| Grade 4 (most severe) | FEV1:FVC <0.70 and FEV1 <30% of predicted | |||
| Occupational disqualification from firefighting | FEV1 or FVC <70% of predicted, or FEV1 or FVC <80% of predicted and FEV1:FVC <0.75, or | 18–65 yr | Work exposure to dust or fumes | NFPA (2007)23 |
| FEV1 or FVC <90% of predicted and previous diagnosis of asthma | ||||
| Medical impairment ratings | 18–79 yr | Work exposure to dust or fumes | AMA (2008)24 | |
| Class 1 (least severe) | FEV1 65–79% of predicted or FVC 70–79% of predicted | |||
| Class 2 | FEV1 55–64% of predicted or FVC 60–69% of predicted | |||
| Class 3 | FEV1 45–54% of predicted or FVC 50–59% of predicted | |||
| Class 4 (most severe) | FEV1 <45% of predicted or FVC <50% of predicted | |||
| VA disability ratings | 18–79 yr | Served in the U.S. Armed Forces | VA (2023)25,26 | |
| 10% (least severe) | FEV1 71–80% of predicted or FEV1:FVC 0.71–0.80 | |||
| 30% | FEV1 56–70% of predicted or FEV1:FVC 0.56–0.70 | |||
| 60% | FEV1 40–55% of predicted or FEV1:FVC 0.40–0.55 | |||
| 100% (most severe) | FEV1 <40% of predicted or FEV1:FVC <0.40 |
AMA denotes American Medical Association, ATS American Thoracic Society, COPD chronic obstructive pulmonary disease, ERS European Respiratory Society, GLI Global Lung Function Initiative, GOLD Global Initiative for Chronic Obstructive Lung Disease, LLN 5th-percentile lower limit of normal range, NFPA National Fire Protection Association, and VA Department of Veterans Affairs.
The percent of the predicted value is the ratio of the measured value to the predicted healthy value, with normal values typically considered to fall between 80% and 120% of the predicted healthy value. Percent of the predicted and LLN values were determined with the use of race-based GLI-2012 equations or race-neutral GLI-Global equations. When multiple spirometric values were assessed, the value resulting in the more severe rating was used. Additional details regarding assessed and nonassessed criteria are provided in the Supplementary Methods section.