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Dr Albert Rizzo Discusses the Use of Spirometry to Diagnose COPD

Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, discusses the use of forced expiratory volume in 1 second (FEV1) /forced vital capacity (FVC) for the diagnosis of chronic obstructive pulmonary disease.


Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, discusses the use of forced expiratory volume in 1 second (FEV1) /forced vital capacity (FVC) for the diagnosis of chronic obstructive pulmonary disease.

Transcript

Do you see any downfalls with using a fixed FEV1/FCV ratio for COPD diagnosis?

I think spirometry is recognized as still a good tool to identify the airflow obstruction. The most recent guidelines for treating COPD still talk about spirometry, but they don’t put it as the number 1 defining factor. We look at symptoms and exacerbations now. So, FEV1 and FEV1/FCV ratio can still be used to help with certain severity measures and could be a sign of increasing exacerbation, but it’s not the tool we really direct our treatment at.

We look at quality of life and symptoms. For example, can a patient walk at the same level as somebody their age? If they can’t and are more severely impaired, they fall under a category that needs more bronchodilatation. If they are hospitalized for their COPD, now they’re in a category where exacerbations tend to be more common. They need not just bronchodilators, they need inhaled corticosteroids as well to control the exacerbations.

To your original question, the FEV1/FVC ratio has some of its faults. Some people feel that it overdiagnoses COPD in the elderly and underdiagnoses in the younger individuals, but I think that spirometry should be used in conjunction with what the patient’s presenting with—certain symptoms, certain findings on x-ray, certain physical exam findings. So, it’s part of the overall tools that a physician uses to say this patient has a degree of COPD they may want treatment.

 
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