Table of Contents
ISRN Pulmonology
Volume 2012, Article ID 109295, 5 pages
Research Article

FEV1/FEV6: A Reliable, Easy-to-Use, and Cheaper Alternative to FEV1/FVC in Diagnosing Airway Obstruction in Indian Population

1Department of Medicine, Rajendra Institute of Medical Sciences, Jharkhand, Ranchi 834009, India
2Department of Respiratory Medicine, L.R.S. Institute of Tuberculosis and Respiratory Diseases, New Delhi, India

Received 17 July 2012; Accepted 18 September 2012

Academic Editors: K. Nishimura and B. A. Rybicki

Copyright © 2012 Anupam Kumar Singh and Amit Lohia. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. FEV1/FEV6 has been proposed as a cheap, reproducible and valid alternative to FEV1/FVC in spirometry. No Indian data exists on its utility to diagnose airway obstruction. Aim. we sought to determine a fixed cut off of FEV1/FEV6 to diagnose obstruction corresponding to FEV1/FVC < 0.70 proposed by GOLD guidelines. Method. Spirometry was done on patient referred to a tertiary centre in India. Age, sex, height weight were recorded in addition to spirometric variables like FEV1, FVC, FEV6. The sensitivity, specificity, positive and negative predictive values of FEV1/FEV6 were determined with respect to gold standard of FEV1/FVC < 0.70. Results. 467 spirometries were analysed after meeting the ATS acceptability criteria. Considering FEV1/FVC < 0.7 as being the gold standard for obstruction, ROC curve was used to determine the best corresponding cut-off for FEV1/FEV6. The area under the curve was 99.3% (95% CI: 98.1–99.8%), and the FEV1/FEV6 cut-off, corresponding to the greatest sum of sensitivity and specificity, was 73%. For the total population, the FEV1/FEV6 sensitivity, specificity, PPV, NPV were was 95.7 %, 94.2 %, 87.5 % and 97.9 % respectively. Agreement by Kappa value between two cut offs was excellent 0.89 (0.87–0.91). Conclusion. FEV1/FEV6 < 73% is a new reliable spirometry index to diagnose airway obstruction in Indian population.