Chronic Obstructive Pulmonary Disease
A practical approach is using only GOLD stages ≥II for establishing COPD diagnosis among the elderly.56
≥50 years the positive predictive value of pre-bronchodilator airflow obstruction was 84.2 % compared with the post-bronchodilator definition.55
Another option for primary care physicians with no direct approach to official spirometry is to use simple hand-held expiratory flow meters
that measure FEV1/FVC6 ratio, as FVC6 could be used as a good alternative to FVC.57
In a study among 204 undiagnosed current and
former smokers >50 years old, the pre-bronchodilator FEV1/FEV6 cut-off point of 0.75 showed a positive predictive value of 52 % and
negative predictive value of 91 % for COPD case-finding.58 In another
study among 1,078 subjects >40 years old who visited a GP (current smokers 48.4 %), the combination of positive International Primary Care Airways Guidelines (IPAG) questionnaire (>17 points) plus
post-bronchodilation FEV1/FVC6 <0.7 showed a positive predictive value of 71 % and negative predictive value of 97 % for COPD case-finding.59
A simplified diagnostic algorithm of COPD in the primary care setting is proposed in Figure 2 taking into account that we are far
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