Spirometric Reference Values for the 6-s FVC Maneuver

Abstract

The guidelines of the National Lung Health Education Program for COPD screening proposed a shorter FVC maneuver (forced expiratory volume at 6 s of exhalation [FEV(6)]). Although reference values for FEV(6) are available from the third National Health and Nutrition Examination Survey, forced expiratory flow between 25% and 75% of FVC (FEF(25-75%)) reference values for the shorter 6-s maneuver are not available and are needed. In particular, calculation of largest observed volume during the first 6 s of an FVC maneuver (FVC(6)), from a shortened FVC maneuver, is necessary because the FEF(25-75%) measurement is based on a percentage of FVC or, for a shorter maneuver, FVC(6). We reanalyzed the raw volume-time curves from the third National Health and Nutrition Examination Survey to calculate FVC(6), forced expiratory volume at 0.5 s of exhalation, forced expiratory volume at 3 s of exhalation, ratio of the FEV(1) to largest observed volume during the first 6 s of an FVC maneuver expressed as a percentage (FEV(1)/FEV(6)%), and forced expiratory flow between 25% and 75% of the largest observed volume during the first 6 s of an FVC maneuver (FEF(25-75%6)) in addition to the previously reported values for FEV(1), FEV(6), and FEV(1)/FEV(6)%. Using the same normal, asymptomatic, nonsmoking reference population from a previous study, reference values for these parameters were derived from best values. A total of 2,261 white, 2,564 African-American, and 2,666 Mexican-American subjects aged 8 to 80 years were included in the analysis. Fifty-four subjects from the previous study were not included due to missing raw volume-time curves. These reference values, utilizing the FVC(6), provide investigators with the means of evaluating the relative merits of using the shorter FVC maneuver as a surrogate for the traditional FVC. They are needed particularly for calculating FEF(25-75%), as statistically significant differences were observed between the FEF(25-75%) and FEF(25-75%6).