Expanding the Potential of Spirometry to Identify Early Impairment in COPD

While spirometry is well validated in the diagnosis of chronic obstructive pulmonary disease, the full potential of spirometry to identify early disease has not been completely explored, according to a review published in Respiratory Medicine.

Although a wide range of spirometric parameters are routinely reported, clinical use of measures other than the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the ratio of these 2 measures has been limited. Thus, researchers reviewed the literature to explore the theoretic ability of spirometry to capture fine pathophysiologic changes in early airway disease, to highlight the shortcomings of current diagnostic criteria, and to discuss existing evidence for spirometric measures that may be used to better detect early airflow impairment.

They found that spirometry may be an ideal diagnostic tool because it is widely performed. As advances are made in the understanding of biologic mechanisms underlying early airway disease, the possibility exists to better understand and use spirometry, particularly in an era of digital spirometry. Early airflow compromise may be identified through measures such as FEV1/FEV6 or FEV3/FEV6, and growing interest in curvilinearity may provide more granular assessment of lung function. In addition, machine learning holds promise for curve analysis, which may detect subtle patterns that distinguish early pathophysiologic changes from the expected changes of aging.

“There is a need for organization within the field of spirometry to prioritize and expand investigation into promising metrics to drive clinical practice,” the authors concluded. “It is of crucial importance that investigational efforts in this field continue, in line with the premise that spirometry goes far beyond FEV1/FVC,” they added.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Hoesterey D, Das N, Janssens W, et al. Spirometric indices of early airflow impairment in individuals at risk of developing COPD: spirometry beyond FEV1/FVC. Respir Med. 2019;156:58-68.