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DIAGNOSTIC VALUE OF THE FEV 1 /FEV 6 TO DETECT AIRWAY OBSTRUCTION

DIAGNOSTIC VALUE OF THE FEV 1 /FEV 6 TO DETECT AIRWAY OBSTRUCTION. Gaye Ulubay, Nursel Türkoğlu , Sevinç S. Ulaşlı, Şule Akçay, Füsun Ö. Eyüboğlu Baskent University Department of Pulmonary Diseases, Ankara.

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DIAGNOSTIC VALUE OF THE FEV 1 /FEV 6 TO DETECT AIRWAY OBSTRUCTION

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  1. DIAGNOSTIC VALUE OF THE FEV1/FEV6 TO DETECT AIRWAY OBSTRUCTION Gaye Ulubay, Nursel Türkoğlu, Sevinç S. Ulaşlı, Şule Akçay, Füsun Ö. Eyüboğlu Baskent University Department of Pulmonary Diseases, Ankara

  2. FEV1/FEV6 was found to be an accurate and reliable alternative for the FEV1/FVC for diagnosing airway obstruction. Enright et al. Res Med, 2002;96:444-449. Swanney et al. AJRCCM 2000;162-917-919 ERS monograph, 2005;1-11 Vandevoorde et al. Chest 2005;127:1560-1564

  3. WHY FEV6 ? • Easier for older patients and those with severe respiratory diseases. • FEV6 is more reproducible than FVC. • Shorter maneuvers reduce the risk of syncope. • In some studies specificity was close to FVC. Ferguson et al. Chest 2000;117:1146-1161 Swanney et al. AJRCCM 2000;162-917-919 Vandevoorde et al. Chest 2005;127:1560-1564.

  4. PURPOSE • Evaluation of the relationship between FEV1/FVC and FEV1/FEV6 in diagnosis of airway obstruction.

  5. MATERIALS AND METHODS-1 • The pulmonary function tests ( PFT ) results of all 1509 subjects tested between 2003-2005, were retrospectively analyzed.

  6. MATERIALS AND METHODS-2 • Indications • Accurate diagnosis • Smoking status were ignored.

  7. Exclusion Criteria • Subjects with no cooperation • < 10 years old and >80 years old were excluded from study. • Recent test results were taken from the subjects with repeated tests.

  8. FVC maneuver was performed in accordance with ERS (European Respiratory Society) criteria. ERS 1993 update. Eur Respir J. 1993;6(suppl 16):5-40.

  9. Airway obstruction was defined as FEV1/ FVC < 70%. • Classification of level of airway obstruction according to ERS. Siafakas et al, ERJ 1995,8:1398-1420

  10. Statistical Methods • All analyses were performed using SPSS software (Statistical Package for the Social Sciences, version 9.05, SSPS Inc, Chicago, Ill, USA). • Lineer Regression Analysis • Spearman’s Correlation Analysis

  11. RESULTS

  12. Subject Demographics

  13. n=495 obstruction n=497 n=200 no obstruction n=317 female male

  14. Distribution of the Subjects According to Severity of the Airway Disease 9% 11% 15% 65% No obstruction Mild = FEV170 % Moderate = 50 % ≤-FEV1 < 70 % Severe = FEV1 < 50 % Mild Moderate Severe

  15. PERCENT 80% 30% DECADES • I=10-20yr • II=21-40yr • III=41-60yr • IV=> 60yr No obstruction Obstruction IV II III I

  16. Whole group P  0.0001, r = 0.979, r2= 0.954

  17. FEV1/ FVC = [FEV1/ FEV6 x 1,17 ]-15,16

  18. In subjects with airway obstruction FEV1/FEV6 specificity 100 % sensitivity 78.3 % positive predictive value 100 % negative predictive value 90 %

  19. FEV1/FEV6 did not detect obstruction in 10% of cases with FEV1/FVC< 70 .

  20. FEV1/FEV6 and Degree of Obstruction

  21. When FEV1 decreased, rate of detected obstruction with FEV1/FEV6 increased.

  22. This result was attributed to unexpired volume at sixth second in severely obstructed subjects.

  23. FEV1/FEV6

  24. FEV1/FEV6 according to age distribution Detecting airway obstruction with FEV1/FEV6 was not affected by age. P> 0.05

  25. DISCUSSION

  26. Specificity of FEV1/FEV6 in our study was similar with other studies but sensitivity was lower than other studies. • FEV1/FEV6 may be used in detecting airway obstruction in general population. Swanney et al. AJRCCM 2000;162-917-919 Vandevoorde et al. Chest 2005;127:1560-1564. Demir T. et al Res Med, 2005:99;103-106 Akpınar M et al. ERJ, 2006:27;374-377.

  27. Lower sensitivity of FEV1/FEV6 in our study may be due to different numbers and distribution of obstructed subjects in other studies.

  28. No difference among age decades in detecting airway obstruction was found. • Therefore FEV1/FEV6may be used in all subjects between 10-80 yrs old.

  29. Underestimation of obstruction with FEV1/FEV6 in 10% of cases. • Disadvantage of FEV1/FEV6 .

  30. CONCLUSION

  31. FEV1/FEV6 use could be appropriate in primary care and field studies as a screening test.

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