To explore the value of handheld COPD-6 spirometry for early COPD detection in high risk elderly population in community.

From January 2018 to December 2019 at Dongshan Community Health Service Center, Jiangning District, Nanjing City, a free physical examination was performed on the elder population over 60 years who had high risk factors of COPD. Handheld COPD-6 spirometry was performed pre- and post-bronchodilator, the forced expiratory volume in one second (FEV₁) , the forced expiratory volume in one second as a percentage of the predicted value (FEV₁%prep) , the forced expiratory volume in six second (FEV₆) , the percentage of forced expiratory volume in six second to the predicted value (FEV₆%prep) , and the value of FEV₁/FEV₆ were evaluated and recorded. With FEV₁/FEV₆<80% as the initial screening positive pre-bronchodilator, retests were performed both with handheld COPD-6 spirometry and confirmatory spirometry after inhaling bronchodilator. Using FEV₁/Forced vital capacity (FVC) <70% as the gold standard by confirmatory spirometry, receiver-operator characteristic (ROC) curve analysis was used to obtain the best diagnostic threshold of FEV₁/FEV₆. Sensitivity, specificity, positive predictive value, and negative predictive value were used to evaluate the diagnostic value of the handheld COPD-6 spirometer.

Out of the 382 participants, COPD was confirmed in 75 according to FEV₁/FVC<70% post-bronchodilator. There was no statistically significant difference between FEV₁%pred pre- and post-bronchodilator by handheld COPD-6 spirometry (t=-0.971, P=0.703) ; There was no statistically significant difference among FEV₁%pred in two tests (t=-2.352, -1.429; P=0.396, 0.058) . The FEV₁%pred detected by handheld COPD-6 spirometry post-bronchodilation was positively correlated with confirmatory spirometry (r=0.969, P<0.05) . Compared with FVC%pred and FEV₆%pred post-bronchodilation, the difference was statistically significant (t=-3.170, P=0.005) ; and the FEV₆%pred was positively correlated with the FVC%pred (r=0.653, P<0.05) . There was no statistically significant difference between FEV₁/FEV₆ and FEV₁/FVC post-bronchodilation (t=1.735, P=0.084) ; and there was substantial agreement between the two diagnostic (r=0.871, P<0.05) . The FEV₁/FEV₆ cut-off with the greatest sum of sensitivity and specificity was 71% pre-bronchodilator, the sensitivity, specificity, positive and negative predictive values were 80.0%, 79.2%, 90.6% and 48.5% respectively. The greatest sum of sensitivity and specificity was 75% post-bronchodilator, the sensitivity, specificity, positive and negative predictive values were 80.0%, 98.8%, 98.4% and 58.3% respectively.

It is feasible to use FEV₁/FEV₆ as an indicator to screen COPD patients in elderly high-risk populations. It is recommended to use FEV₁/FEV₆<71% before bronchodilation and FEV₁/FEV₆<75% after diastole as the screening criteria.

探讨便携式COPD-6肺量计筛查社区老年高危人群早期COPD的价值。

选取2018年1月至2019年12月在南京市江宁区东山街道社区卫生服务中心进行免费体检的60岁及以上且具有COPD高危因素人群为研究对象，均行肺功能检查。对研究对象行便携式COPD-6肺量计检测，记录第1秒用力呼气末容积（FEV₁）、第1秒用力呼气末容积占预计值百分比（FEV₁%prep）、第6秒用力呼气末容积（FEV₆）、第6秒用力呼气末容积占预计值百分比（FEV₆%prep）、FEV₁/FEV₆。以FEV₁/FEV₆<80%为初筛阳性，研究对象吸入支气管扩张剂后使用便携式COPD-6肺量计复测肺功能，同时进行常规肺功能检测。以常规肺功能检测FEV₁/用力肺活量（FVC）<70%为金标准，应用受试者工作特征曲线（ROC曲线），计算FEV₁/FEV₆最佳截断值，采用灵敏度、特异度、阳性预测值、阴性预测值评价便携式COPD-6肺量计的诊断价值。

382例体检者共有97例符合质控要求的COPD初筛阳性者，再以支气管舒张后FEV₁/FVC<70%为持续气流受限诊断标准，共检出COPD患者75例。使用支气管舒张剂前、后便携式COPD-6肺量计检测FEV₁%pred比较，差异无统计学意义（t=-0.971，P=0.703）；使用支气管舒张剂前、后便携式COPD-6肺量计检测FEV₁%pred分别与常规肺功能检测比较，差异均无统计学意义（t=-2.352、-1.429，P=0.396、0.058）。支气管舒张后便携式COPD-6肺量计检测FEV₁%pred与常规肺功能检测FEV₁%pred呈正相关（r=0.969，P<0.05）。支气管舒张后便携式COPD-6肺量计检测FEV₆%pred与常规肺功能检测FVC%pred比较，差异有统计学意义（t=-3.170，P=0.005），且两者呈正相关（r=0.653，P<0.05）。使用支气管舒张剂后便携式COPD-6肺量计检测FEV₁/FEV₆与常规肺功能检测FEV₁/FVC比较，差异无统计学意义（t=1.735，P=0.084），但两者仍呈正相关（r=0.871，P<0.05）。使用支气管舒张剂前当FEV₁/FEV₆截断值<71%时，根据ROC曲线计算得出约登指数最大为57.9%，灵敏度为80.0%，特异度为77.9%，阳性预测值为90.6%，阴性预测值为48.5%；使用支气管舒张剂后当FEV₁/FEV₆截断值<75%时，约登指数最大为75.5%，灵敏度为80.0%，特异度为95.5%，阳性预测值为98.4%，阴性预测值为58.3%。

FEV₁/FEV₆作为筛查老年高危人群中COPD的指标是可行的，推荐使用支气管舒张剂前用FEV₁/FEV₆<71%，使用支气管舒张剂后用FEV₁/FEV₆<75%作为筛查的标准。