No abstract

Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

The purpose of this study was to determine fixed cut-off points for forced expiratory volume in one second (FEV1)/FEV6 and FEV6 as an alternative for FEV1/forced vital capacity (FVC) and FVC in the detection of obstructive and restrictive spirometric patterns, respectively.For the study, a total of 11,676 spirometric examinations, which took place on Caucasian subjects aged between 20-80 yrs, were analysed. Receiver-operator characteristic curves were used to determine the FEV1/FEV6 ratio and FEV6 value that corresponded to the optimal combination of sensitivity and specificity, compared with the commonly used fixed cut-off term for FEV1/FVC and FVC.The data from the current study indicate that FEV1/ FEV6 ,73% and FEV6 ,82% predicted can be used as a valid alternative for the FEV1/FVC ,70% and FVC ,80% pred cut-off points for the detection of obstruction and restriction, respectively. The statistical analysis demonstrated very good, overall, agreement between the two categorisation schemes. For the spirometric diagnosis of airway obstruction (prevalence of 45.9%), FEV1/FEV6 sensitivity and specificity were 94.4 and 93.3%, respectively; the positive and negative predictive values were 92.2 and 95.2%, respectively. For the spirometric detection of a restrictive pattern (prevalence of 14.9%), FEV6 sensitivity and specificity were 95.9 and 98.6%, respectively; the positive and negative predictive values were 92.2 and 99.3%, respectively.This study demonstrates that forced expiratory volume in one second/forced expiratory volume in six seconds ,73% and forced expiratory volume in six seconds ,82% predicted, can be used as valid alternatives to forced expiratory volume in one second/forced vital capacity ,70% and forced vital capacity ,80% predicted, as fixed cut-off terms for the detection of an obstructive or restrictive spirometric pattern in adults.

The present study aims to derive guidelines that identify patients for whom spirometry can reliably predict a reduced total lung capacity (TLC). A total of 12,693 lung function tests were analysed on Caucasian subjects, aged 18-70 yrs.Restriction was defined as a reduced TLC. Lower limits of normal (LLN) for TLC were obtained from the European Respiratory Society recommended reference equations. Reference equations from the National Health and Nutrition Examination Survey III were used for forced vital capacity (FVC) and forced expiratory volume in six seconds (FEV6). The performance of FVC and FEV6 to predict the presence of restriction was studied as follows: 1) using two-by-two (262) tables; and 2) by logistic regression analysis. Both analyses were performed in obstructive (defined as forced expiratory volume in one second (FEV1)/FVC or FEV1/FEV6 ,LLN) and nonobstructive subgroups, and separately for males and females.The 262 tables showed generally low positive and high negative predictive values for FVC or FEV6 below their LLN in predicting a reduced TLC. Logistic regression analysis showed that in nonobstructive subjects, restriction can be positively predicted if FVC or FEV6 is ,55% predicted (males) or ,40% pred (females). Restriction can be ruled out if FVC or FEV in six seconds is .100% pred (males) or .85% pred (females).In obstructive patients, spirometry cannot reliably diagnose a concomitant restrictive defect, but it can rule out restriction for patients with forced vital capacity or forced expiratory volume in six seconds .85% pred (males) or .70% pred (females).KEYWORDS: Forced expiratory volume in six seconds, forced vital capacity, restrictive ventilatory defect, spirometry, total lung capacity P ulmonary function tests are performed to diagnose or rule out obstructive, restrictive or mixed ventilatory defects [1]. Airway obstruction is directly defined by spirometry and is characterised by the presence of a low forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) or FEV1/ forced expiratory volume in six seconds (FEV6) ratio [1][2][3]. The spirometric diagnosis of restriction is more problematic; while the presence of a restrictive pulmonary impairment can be suspected if FVC or FEV6 are low, their positive predictive value (PPV) is low, e.g. 58% in a study population of 264 White patients with a low FVC and a normal FEV1/FVC ratio [4]. Current interpretative guidelines are based on the assumption that a reduced total lung capacity (TLC) is the gold standard for the diagnosis of a restrictive ventilatory defect, thus requiring lung volume measurement by gas dilution or whole body plethysmography techniques [1].Previous studies have demonstrated that FEV6 can be a reliable surrogate for FVC in the detection of obstruction as well as in the exclusion of restriction [2,3,5,6]. As FEV1/FVC (or FEV1/vital capacity (VC)) is considered as a ''de facto gold standard'' for the detection of obstruction, FEV6 can never be shown to outperform FVC (or VC) in the denominator ...

The aim of this study was to assess the interventions by general practitioners on cardiovascular risk factors among persons without a history of cardiovascular disease attending for a cardiovascular check-up. All inhabitants of three Belgian towns aged between 45 and 64 years were invited for a cardiovascular check-up and blood test. Of all the attending persons without a history of cardiovascular disease (n = 898), 51% received at least one prescription, diet or health advice: 28% for hyperlipidaemia, 23% for physical activity, 22% for caloric intake, 9% for blood sugar, 5% for blood pressure and 4% for smoking. Interventions on lipoproteins, blood sugar and smoking habits were significantly more often proposed to persons with a medium or high cardiovascular risk compared to those at low cardiovascular risk. For persons at low cardiovascular risk, therapeutic lifestyle changes are often not advised, and isolated risk factors often remain untreated.