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.

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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