Abstract

Dr. Kanwal Fatima Khalil*

ABSTRACT

Background: Traditionally spirometric criteria of post-bronchodilator FEV1/FVC is used to define Chronic Obstructive Pulmonary Disease(COPD). This has been termed as forced expiratory ratio(FER)(1). It is however, well observed that people who smoke even if do not fulfill the GOLD definition, still continue to experience symptoms and behave in a similar manner. This indicates that the current criteria of diagnosis of COPD may not be sufficient in all cases. Objective: To compare the validity of FEV1 regardless of ratio (FRR) with GOLD defined COPD (Forced expiratory ratio FER) and to identify patients with PRISM as a separate group. Methods: It was an analytical type of study undertaken in the Department of Pulmonology, Fauji Foundation Hospital Rawalpindi on 123 stable patients, who presented to the outpatient department (OPD) for evaluation of their symptoms, from July 2015 to August 2017. Data was analyzed by calculating frequencies and percentages using SPSS version 20. Validity of FER, FRR was calculated by checking the sensitivity, specificity, positive and negative predictive values. PRISM was identified as a subgroup. Results: The mean age of patients was 63.41 +10.28. Around 108(87.80%) of patients were male while 15(12.20%) were female. GOLD Defined COPD group and the PRISM groups were comparable with no statistically significant difference in their mean age, smoking status, arterial blood gas values and the six minute walk test. The sensitivity and specificity of GOLD defined COPD is modest (53.50% and 45.50%) and FEV1 regardless of ratio(FRR) has got an improved sensitivity (98.2%) and positive predictive value (91.66%). Discussion: The sensitivity of FRR in the present study was more than 90% ; implicating its use in mass screening programs for COPD, in the communities and multiple health care centers of the world. Conclusion: Using FEV1 regardless of ratio (FRR) is a an easy and widely available parameter that can be useful in future hence reducing the morbidity and mortality that can be a consequence of missing a diagnosis.