Screening Tool for Restrictive and Obstructive Ventilatory Abnormalities in a Population-Based Survey

Area of Science:

• Pulmonary Medicine
• Diagnostic Spirometry
• Public Health Screening

Background:

• A 6-second spirometry using an inexpensive pocket spirometer can efficiently select individuals for diagnostic spirometry.
• It may also be useful in identifying individuals with a restrictive lung pattern.

Purpose of the Study:

• To evaluate an inexpensive simplified spirometer, the COPD-6, as a screening tool for spirometric abnormalities.
• To assess its utility in identifying both obstructive and restrictive lung diseases.

Main Methods:

• A population-based survey in Mexico City with 742 participants.
• Participants performed pre- and post-bronchodilator (BD) spirometry and a three-maneuver 6-second spirometry using a COPD-6 device.
• Receiver operating characteristic analysis was used to evaluate forced expiratory volume in 1 second (FEV1), FEV6, and FEV1/FEV6 to discriminate airflow obstruction or restriction.

Main Results:

• FEV1 as a percentage of predicted (FEV1%P) was the best predictor of ventilatory abnormalities.
• A cutoff point of 87%P demonstrated high area under the curve (AUC) for restrictive (92%), obstructive (89%), and any spirometric abnormality (91%).
• Screening individuals with FEV1%P < 87% (26% of the sample) identified most spirometric abnormalities, with only 12% of mild abnormalities missed.

Conclusions:

• A pre-bronchodilator 6-second spirometry using FEV1 < 87%P effectively identifies individuals with spirometric ventilatory defects.
• This screening method can accurately detect both obstructive and restrictive lung diseases.