Published: 2017-09-22

Comparison of FEV1/FEV6 with FEV1/FVC in the diagnosis of COPD

D. Ranganath, M. Ravindranath


Background: Globally COPD occurs. But it is a health hazard among those who smoke. The life expectancy is also reduced to a large extent. Hence early diagnosis may help prevent further progression of disease and motivate people to modify their lifestyle.

Methods: Patients aged 40 years and above, attending to pulmonology OPD and in-patients with symptoms suggestive of COPD were subjected to spirometric examinations following standard protocol of test performance as laid down by ATS/ERS. Spirometric examinations were analyzed statistically to know the performance of FEV1/FEV6 ratio using a cut-off value of < 0.70 (post bronchodilator) arbitrarily as against FEV1/FVC ratio of < 0.70 (post bronchodilator) in accordance with GOLD guidelines for the diagnosis of COPD.

Results: Majority (83.8%) were male. Out of 229 patients 197 patients had airways obstruction as per post bronchodilator FEV1/FVC of < 0.70. Among 197 patients who were diagnosed as having COPD as per post bronchodilator FEV1/FVC ratio, 180 (91.37%) patients had an FEV1/FEV6 value < 0.70. Among 192 male patients, 170 were diagnosed as having COPD as per post bronchodilator FEV1/FVC ratio of < 0.70 as against 153 as per post bronchodilator FEV1/FEV6 ratio of < 0.70. Among 37 female patients 27 were found to have COPD based on both FEV1/FVC and FEV1/FEV6 post bronchodilator values.

Conclusions: FEV1/FEV6 ratio is an acceptable alternative to FEV1/FVC ratio in the diagnosis of COPD in patients aged 40 years and above and with risk factors for COPD.


COPD, FEV1/FEV6 ratio, Risk factors

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Fletcher CM, Tinker CM, Peto R, Speizer FE. The natural history of chronic bronchitis and emphysema. Oxford. Oxford University Press; 1976.

Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932-46.

Salvi S. COPD, The neglected epidemic. In: Jindal SK, editor. Textbook of Pulmonary and Critical Care Medicine, Vol 2, 1st ed. Jaypee Publications: New Delhi. 2011;971-974.

The Global Burden of Disease, WHO 2008 Oct. Available at /global burden_disease/projections/en/index.html.

Reddy KS, Gupta PC. Report on tobacco control in India. New Delhi: Ministry of Health and Family Welfare, Government of India; 2004:99-102.

Pande JN, Khilnani GC. Epidemiology and etiology. In: Shankar PS, editor. Chronic obstructive pulmonary disease. Mumbai: Indian College of Physicians; 1997:10-22.

Nigam P, Verma BL, Srivastava RN. Chronic bronchitis in an Indian rural community. J Assoc Physicians India. 1982;30:277-80.

Thiruvengadam KV, Raghava TP, Bhardwaj KV. Survey of prevalence of chronic bronchitis in Madras city. In: Viswanath R, Jaggi OP, editors. Advances in chronic obstructive lung disease. Delhi: Asthma and Bronchitis Foundation of India; 1977:59-69.

Rabe KF, Hurd S, Anzueto A. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532-55.

Lopez AD, Shibuya K, Rao C. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397-412.

Halbert RJ, Isonaka S, George D. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest. 2003;123:1684-92.

Enright PL, Kaminsky DA. Strategies for screening for chronic obstructive pulmonary disease. Respir Care. 2003;48:1194-201.

Bellia V, Sorino C, Catalano F. Validation of FEV6 in the elderly: correlates of performance and repeatability. Thorax. 2008;63:60-6.

Glindmeyer HW, Jones RN, Barkman HW. Spirometry: quantitative test criteria and test acceptability. Am Rev Respir Dis. 1987;136:449-52.

Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest. 2000;117:1146-61.

Swanney MP, Jensen RL, Crichton DA. FEV6 is an acceptable surrogate for FVC in the spirometric diagnosis of airway obstruction and restriction. Am J Respir Crit Care Med. 2000;162:917-9.

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2011. Available at http://

Medical section of the American Lung Association. Lung Function Testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144:1202-18.

Pellegrino R, Viegi G, Brusasco V, Crapo R, Burgos F, Casaburi R. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-68.

Melbye H, Medbo A, Crockett A. The FEV1/FEV6 ratio is a good substitute for the FEV1/FVC ratio in the elderly. Prim Care Respir J. 2006;15:294-8.

Rosa FW, Perez-Padilla R, Camelier A. Efficacy of the FEV1/FEV6 ratio compared to the FEV1/FVC ratio for the diagnosis of airway obstruction in subjects aged 40 years or over. Braz J Med Biol Res. 2007;40:1615-21.

Vandevoorde J, Verbanck S, Schuermans D, Kartounian J, Vincken W. Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/FEV6 and FEV6. Eur Respir J. 2006;27:378-83.

Akpinar-Elci M, Fedan KB, Enright PL. FEV6 as a surrogate for FVC in detecting airways obstruction and restriction in the workplace. Eur Respir J. 2006;27:374-7.