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. 2023 Mar;68(3):366-373.
doi: 10.4187/respcare.10191. Epub 2022 Nov 22.

Comparison of New Spirometry Measures to Diagnose COPD

Angélica M Moreno Giraldo  1 , Luis F Giraldo Cadavid  1   2 , Daniel Botero Rosas  3 , Eduardo Tuta Quintero  1 , Adriana Maldonado-Franco  4 , Hermencia C Aponte Murcia  5 , Carlos E Avellaneda Suárez  6 , Lina María Morales Cely  1 , Alirio Rodrigo Bastidas  7
Affiliations

Comparison of New Spirometry Measures to Diagnose COPD

Angélica M Moreno Giraldo et al. Respir Care. 2023 Mar.

Abstract

Background: COPD is diagnosed by using FEV1/FVC, which has limitations as a diagnostic test. We assessed the validity of several measures derived from the expiratory phase of the flow-volume curve obtained from spirometry to diagnose COPD: the slopes that correspond to the volume expired after the 50% and 75% of the FVC, the slope formed between the peak expiratory flow (PEF) and the FVC, and the area under the expiratory flow/volume curve.

Methods: We conducted a cross-sectional diagnostic test study in 765 consecutive subjects referred for spirometry because of respiratory symptoms. We compared the reproducibility and accuracy of the proposed measures against post-bronchodilator FEV1/FVC < 0.70. We also evaluated the proportion of respiratory symptoms for the FEV1/FVC, FEV1 per FEV in the first 6 s (FEV6), and the PEF slope.

Results: The subjects had a mean age of 65.8 y, 57% were women, and 35% had COPD. The test-retest intraclass correlation coefficient values were 0.89, 0.85, and 0.83 for FEV1/FVC, FEV1/FEV6, and the PEF slope, respectively. The area under the curve values were 0.93 (expiratory flow/volume), 0.96 (potential expiratory flow/volume), 0.97 (potential expiratory flow/volume at 75% of FVC), and 0.82 (potential expiratory flow/volume at 50% of FVC). The area under the receiver operating characteristic curve was 0.99 for FEV1/FEV6, 0.99 for the slope at 50% of the FVC, and 0.98 for the PEF slope.

Conclusions: The FEV1/FEV6, PEF slope, and 50% FVC slopes had similar diagnostic performances compared with FEV1/FVC.

Keywords: ROC curve; chronic obstructive; early diagnosis; pulmonary disease; spirometry.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart. FVC = forced vital capacity, PEF = peak expiratory flow.
Fig. 2.
Fig. 2.
Graphic representation of the slope measures proposed in this study. A and B: The estimated slopes through ordinary least squares, from 75% and 50% of the FVC and above, respectively. It is worth noting that the 75% and 50% FVC slopes do not necessarily start at the intersection between the FVC threshold and the expiratory flow/volume curve because it is calculated by regression and captures the average behavior of those portions of the curve. C: The line slope between the peak expiratory flow (PEF) and the FVC. FVC = forced vital capacity.
Fig. 3.
Fig. 3.
The proposed area under the curve (AUC) measures. A and C: The area under the flow/volume curve of the whole expiratory phase and the volume above the 75% FVC, respectively. B and D: The same areas under the curve but the line formed between the highest flow peak and the FVC. FVC = forced vital capacity.
See this image and copyright information in PMC

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