Hao Li1, Chunhong Liu1, Yi Zhang1, Wei Xiao2. 1. Department of Respiratory Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China. 2. Department of Respiratory Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China. xiaowei4226@163.com.
Abstract
BACKGROUND: Spirometry is important for the differential diagnosis of dyspnea. However, some patients cannot exhale for ≥6 s to achieve the American Thoracic Society/European Respiratory Society criteria. The aim of this study was to demonstrate the reliability of a new parameter that quantifies the degree of concavity in the first 3 s to define airway limitation as a surrogate for the FEV1/FVC. METHODS: Four hundred spirometry test results were selected through complete random sampling. The new parameter, termed the AUC3/AT3, was calculated as the area under the descending limb of the expiratory flow-volume curve before the end of the first 3 s (AUC3) divided by the area of the triangle before the end of the first 3 s (AT3). The AUC3/AT3 was compared with the FEV1/FVC using Pearson's correlation analysis. The level of agreement between the AUC3/AT3 and the FEV1/FVC in the detection of airway obstruction was analyzed using the kappa statistic. We also compared the diagnostic accuracy of the new index with that of the FEV1/forced expiratory volume in the first 3 s (FEV3). RESULTS: There was a strong correlation (r = 0.88, P < .001) between the AUC3/AT3 and the FEV1/FVC. There was also strong agreement between the AUC3/AT3 and the FEV1/FVC in the detection of obstruction with kappa indices of 0.72 (Global Initiative for Chronic Obstructive Lung Disease [GOLD] criterion) and 0.67 (lower limit of normal criterion), and these values were greater than those obtained for the FEV1/FEV3. The AUC3/AT3 also exhibited acceptable sensitivity, specificity, positive predictive value, and negative predictive value. The diagnostic accuracies of the AUC3/AT3 were 86.3% (GOLD criterion) and 83.8% (lower limit of normal criterion), which were greater than the 76.0 and 74.0% obtained for the FEV1/FEV3, respectively. CONCLUSIONS: The AUC3/AT3 can be utilized as a surrogate parameter for the FEV1/FVC when patients cannot complete a 6-s expiratory effort. Additionally, the performance of this index is better than that of the FEV1/FEV3 in the identification of airway limitations.
BACKGROUND: Spirometry is important for the differential diagnosis of dyspnea. However, some patients cannot exhale for ≥6 s to achieve the American Thoracic Society/European Respiratory Society criteria. The aim of this study was to demonstrate the reliability of a new parameter that quantifies the degree of concavity in the first 3 s to define airway limitation as a surrogate for the FEV1/FVC. METHODS: Four hundred spirometry test results were selected through complete random sampling. The new parameter, termed the AUC3/AT3, was calculated as the area under the descending limb of the expiratory flow-volume curve before the end of the first 3 s (AUC3) divided by the area of the triangle before the end of the first 3 s (AT3). The AUC3/AT3 was compared with the FEV1/FVC using Pearson's correlation analysis. The level of agreement between the AUC3/AT3 and the FEV1/FVC in the detection of airway obstruction was analyzed using the kappa statistic. We also compared the diagnostic accuracy of the new index with that of the FEV1/forced expiratory volume in the first 3 s (FEV3). RESULTS: There was a strong correlation (r = 0.88, P < .001) between the AUC3/AT3 and the FEV1/FVC. There was also strong agreement between the AUC3/AT3 and the FEV1/FVC in the detection of obstruction with kappa indices of 0.72 (Global Initiative for Chronic Obstructive Lung Disease [GOLD] criterion) and 0.67 (lower limit of normal criterion), and these values were greater than those obtained for the FEV1/FEV3. The AUC3/AT3 also exhibited acceptable sensitivity, specificity, positive predictive value, and negative predictive value. The diagnostic accuracies of the AUC3/AT3 were 86.3% (GOLD criterion) and 83.8% (lower limit of normal criterion), which were greater than the 76.0 and 74.0% obtained for the FEV1/FEV3, respectively. CONCLUSIONS: The AUC3/AT3 can be utilized as a surrogate parameter for the FEV1/FVC when patients cannot complete a 6-s expiratory effort. Additionally, the performance of this index is better than that of the FEV1/FEV3 in the identification of airway limitations.
Authors: Sandeep Bodduluri; Arie Nakhmani; Joseph M Reinhardt; Carla G Wilson; Merry-Lynn McDonald; Ramaraju Rudraraju; Byron C Jaeger; Nirav R Bhakta; Peter J Castaldi; Frank C Sciurba; Chengcui Zhang; Purushotham V Bangalore; Surya P Bhatt Journal: JCI Insight Date: 2020-07-09
Authors: Daniel Hoesterey; Nilakash Das; Wim Janssens; Russell G Buhr; Fernando J Martinez; Christopher B Cooper; Donald P Tashkin; Igor Barjaktarevic Journal: Respir Med Date: 2019-08-09 Impact factor: 3.415
Authors: Surya P Bhatt; Sandeep Bodduluri; Vrishank Raghav; Nirav R Bhakta; Carla G Wilson; Young-Il Kim; Michael Eberlein; Frank C Sciurba; MeiLan K Han; Mark T Dransfield; Arie Nakhmani Journal: Ann Am Thorac Soc Date: 2019-08
Authors: Surya P Bhatt; Nirav R Bhakta; Carla G Wilson; Christopher B Cooper; Igor Barjaktarevic; Sandeep Bodduluri; Young-Il Kim; Michael Eberlein; Prescott G Woodruff; Frank C Sciurba; Peter J Castaldi; MeiLan K Han; Mark T Dransfield; Arie Nakhmani Journal: Sci Rep Date: 2018-11-30 Impact factor: 4.379