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Eur Respir J 2006, doi:10.1183/09031936.06.00136905
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ORIGINAL ARTICLE |
Should FEV6 Replace FVC to detect airway obstruction?
1 Division of Respiratory and Critical Care Physiology and Medicine, Dept of Medicine, Los Angeles Biomedical Institute at Harbor UCLA Medical Center
* To whom correspondence should be addressed. E-mail: jhansen{at}labiomed.org.
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Abstract |
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It has been suggested that FEV6 be substituted for FVC to measure fractions of timed expired volume for airflow obstruction detection. We hypothesized this recommendation might be questionable because flow after 6 seconds of forced expiration, coming from more diseased lung units with the longest time constants, was most meaningful and should not be ignored. Further, prior reported studies comparing FEV6 and FVC included few subjects with mild or no disease.
We utilized spirometric data from the United States Third National Health and Nutrition Evaluation Survey with prior published ethnic- and gender-specific equations for FEV1/FEV6, FEV1/FVC, and FEV3/FVC and new equations for FEV3/FEV6, all derived from approximately 4,000 adult never-smokers aged 20 to 80 years.
At 95 % confidence levels, 21.3% of 3515 smokers and 41.3% of smokers over age 51 had airway obstruction; comparing FEV1/FEV6 with FEV1/FVC, 13.5% were concurrently abnormal, 1.5% were false positives and 4.1% were false negatives; and comparing FEV3/FEV6 with FEV3/FVC, 11.6% were concurrently abnormal, 3.3% were false positives and 5.7% were false negatives.
Substituting FEV6 for FVC to determine the fractional rates of exhaled volumes reduces the sensitivity of spirometry to detect airflow obstruction, especially in older individuals and those with lesser obstruction.
Keywords: Airway obstruction, cigarette smoking, FEV3, FEV6, FVC, spirometry
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