title: FEV1/FEV6 in Primary Care Is a Reliable and Easy Method for the Diagnosis of COPD.
abstract: BACKGROUND
  FEV6 can be used as a convenient alternative to FVC. The aim of this study was to determine an alternative to the fixed cutoff points of FEV1/FVC <0.70 suitable for FEV1/FEV6 in primary care.
  
  
  METHODS
  Pulmonary function testing was conducted on volunteers recruited from 4 community centers in Xi'an, China, between July and August 2012. Participants underwent 3 FVC maneuvers. The maneuver with the best FEV1 was retained. FVC, FEV1, and FEV6 were measured by portable spirometer. The receiver operating characteristic curves that corresponded to the optimal combination of sensitivity and specificity for FEV1/FEV6 were determined. A kappa test was used to compare the agreement between FEV1/FVC and FEV1/FEV6. The positive predictive value and negative predictive value were also calculated.
  
  
  RESULTS
  A total of 767 volunteers participated in this study, of whom 297 were male and 470 were female. Considering FEV1/FVC <0.70 as the accepted standard for COPD, the area under the curve was 98% (P < .001), and the FEV1/FEV6 cutoff, corresponding to the greatest sum of sensitivity and specificity, was 0.72. For the total population, the FEV1/FEV6 sensitivity, specificity, positive predictive value, and negative predictive value were 96.9, 98.8, 95.8, and 99.2%, respectively. The agreement between the 2 cutoff points was excellent, and the kappa value was 0.954.
  
  
  CONCLUSIONS
  FEV1/FEV6 <0.72 can be used in primary care as a valid alternative to FEV1/FVC <0.70 as a fixed cutoff point for the detection of COPD in adults. This study suggests that FEV1/FEV6 is an effective and well validated option that should be used in primary care to detect COPD, which is a rampant problem.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China. wangshengyu@yeah.net.
authors.forename: Shengyu
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
authors.affiliation: Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012372:ROC Curve; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000379:methods*
keywords: COPD; forced expiratory volume in six seconds; pulmonary function testing; spirometry