The Complementary Role of FEV6 in Bronchodilator Reversibility Test for the Old Age

노인환자의 기도가역성 검사에서 FEV6의 보완적 지표로서의 역할

  • Kim, Sae Hee (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Lee, Yang Deok (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Lee, Jung Yun (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Cho, Yong Seon (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Na, Dong Jip (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Han, Min Soo (Department of Internal Medicine, Eulji University School of Medicine)
  • 김새희 (을지의과대학 내과학교실) ;
  • 이양덕 (을지의과대학 내과학교실) ;
  • 이정윤 (을지의과대학 내과학교실) ;
  • 조용선 (을지의과대학 내과학교실) ;
  • 나동집 (을지의과대학 내과학교실) ;
  • 한민수 (을지의과대학 내과학교실)
  • Received : 2006.07.19
  • Accepted : 2006.09.07
  • Published : 2006.09.30

Abstract

Background: In the measurement of bronchodilator reversibility, the forced expiratory volume in one second($FEV_{1}$) and the forced vital capacity(FVC) are commonly used parameters and recommended criteria for the reversibility requiring an increase of more than 200ml and 12% above the baseline, respectively. However, aged patients do not often meet the criteria of an increase in volume(>200ml) even though the medical history of that patient is adequate for asthma. This study investigated the role of the forced expiratory volume in six seconds($FEV_{6}$) in the bronchodilator reversibility test in elderly patients. Methods: A total of 236 patients more than 65 years of age with a $FEV_{1}$/FVC ratio<80% were enrolled in this study. The bronchodilator revesibility tests were examined. With the setting $FEV_{1}$ as the baseline, the patients were divided into three groups; Group I : $$FEV_{1}{\geq_-}80%$$ of the predicted value, Group II : 60%<$FEV_{1}$<80% of the predicted value, Group III : $$FEV_{1}{\leq_-}60%$$ of the predicted value. Results: Positive reversibility in the $FEV_{1}$, $FEV_{6}$, and FVC was in 33(14.0%), 49(20.8%) and 55(23.3%). However, Group III presented with reversibility in the $FEV_{1}$, $FEV_{6}$, and FVC in 15(22.4%), 30(44.8%) and 32(47.8%) respectively. Conclusions: The $FEV_{6}$ might be used as a complementary parameter in bronchodilatror reversibility in elderly patients. However, more study will be needed to determine the usefulness of $FEV_{6}$ in bronchodilator reversibility test.

Acknowledgement

Supported by : 을지의과대학교

References

  1. Killian KJ, Summers E, Watson RM, O'Byrne PM, Jones NL, Campbell EJ. Factors contributing to dyspnoea during bronchoconstriction and exercise in asthmatic subjects. Eur Respir J 1993:6:1004-10
  2. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005:26:319-38 https://doi.org/10.1183/09031936.05.00034805
  3. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005:26:948-68 https://doi.org/10.1183/09031936.05.00035205
  4. Stoller JK, Buist AS, Burrows B, Crystal RG, Fallat RJ, McCarthy K, et al. Quality control of spirometry testing in the registry for patients with severe alpha1-antitrypsin deficiency: alpha1-Antitrypsin Deficiency Registry Study Group. Chest 1997:111:899-909 https://doi.org/10.1378/chest.111.4.899
  5. Eaton T, Withy S, Garrett JE, Mercer J, Whitlock RM, Rea HH. Spirometry in primary care practice: the importance of quality assurance and the impact of spirometry workshops. Chest 1999:116:416-23 https://doi.org/10.1378/chest.116.2.416
  6. Swanney MP, Beckert LE, Frampton CM, Wallace LA, Jensen RL, Crapo RO. Validity of the American Thoracic Society and other spirometric algorithms using FVC and forced expiratory volume at 6 s for predicting a reduced total lung capacity. Chest 2004:126:1861-6 https://doi.org/10.1378/chest.126.6.1861
  7. Akpinar-Elci M, Fedan KB, Enright PL. FEV6 as a surrogate for FVC in detecting airways obstruction and restriction in the workplace. Eur Respir J 2006:27:374-7 https://doi.org/10.1183/09031936.06.00081305
  8. American Thoracic Society. Standardization of Spirometry, 1994 update. Am J Respir Crit Care Med 1995:152:1107-36 https://doi.org/10.1164/ajrccm.152.3.7663792
  9. Pellegrino R, Rodarte JR, Brusasco V. Assessing the reversibility of airway obstruction. Chest 1998:114: 1607-12 https://doi.org/10.1378/chest.114.6.1607
  10. Lorber DB, Kaltenborn W, Burrows B. Responses to isoproterenol in a general population sample. Am Rev Respir Dis 1978:118:855-61
  11. Dales RE, Spitzer WO, Tousignant P, Schechter M, Suissa S. Clinical interpretation of airway response to a bronchodilator: epidemiologic considerations. Am Rev Respir Dis 1988:138:317-20 https://doi.org/10.1164/ajrccm/138.2.317
  12. Anthonisen NR, Wright EC. Bronchodilator response in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986:133:814-9
  13. Sourk RL, Nugent KM. Bronchodilator testing: confidence intervals derived from placebo inhalations. Am Rev Respir Dis 1983:128:153-7 https://doi.org/10.1164/arrd.1983.128.1.153
  14. Enright RL, Connett JE, Bailey WC. The FEV1/FEV6 predicts lung function decline in adult smokers. Respir Med 2002:96:444-9 https://doi.org/10.1053/rmed.2001.1270
  15. Vandevoorde J, Verbanck S, Schuermans D, Kartounian J, Vincken W. Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/FEV6 and FEV6. Eur Respir J 2006:27:378-83 https://doi.org/10.1183/09031936.06.00036005
  16. Demir T, Ikitimur HD, Koc N, Yildirim N. The role of FEV6 in the detection of airway obstruction. Respir Med 2005:99:103-6 https://doi.org/10.1016/j.rmed.2004.05.016
  17. Killian KJ, Watson R, Otis J, St Amand TA, O'Byrne PM. Symptom perception during acute bronchoconstriction. Am J Respir Crit Care Med 2000:162:490-6 https://doi.org/10.1164/ajrccm.162.2.9905079
  18. Kendrick AH, Higgs CM, Whitfield MJ, Laszlo G. Accuracy of perception of severity of asthma: patients treated in general practice. BMJ 1993:307:422-4 https://doi.org/10.1136/bmj.307.6901.422
  19. Nowak RM, Pensler MI, Sarkar DD, Anderson JA, Kvale PA, Ortiz AE, et al. Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma. Ann Emerg Med 1982:11:64-9 https://doi.org/10.1016/S0196-0644(82)80298-9
  20. Dow L. Asthma in older people. Clin Exp Allergy 1998:28:195-202 https://doi.org/10.1046/j.1365-2222.1998.028s5195.x