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Vol. 54. Num. 9.September 2018
Pages 445-494
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Vol. 54. Num. 9.September 2018
Pages 445-494
Original Article
DOI: 10.1016/j.arbr.2018.07.008
Usefulness of the Piko-6 Portable Device for Early COPD Detection in Primary Care
Utilidad del dispositivo portátil Piko-6 para la detección precoz de la enfermedad pulmonar obstructiva crónica en atención primaria
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Vanesa Hidalgo Sierraa, Miguel Ángel Hernández Mezquitab,
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mhmezquita@gmail.com

Corresponding author.
, Luis Palomo Cobosc, Myriam García Sánchezb, Ramón Diego Castellanosa, Soraya Jodra Sánchezb, Rosa Cordovilla Pérezb,d,e, Miguel Barrueco Ferrerob,d,e
a Centro de Salud de Béjar, Salamanca, Spain
b Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca, Spain
c Centro de Salud Cáceres Centro, Cáceres, Spain
d Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
e IBSAL, Salamanca, Spain
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Figures (4)
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Tables (5)
Table 1. Mean Values and Differences of Parameters Determined by Spirometry and Piko-6.
Table 2. Contingency Table of Number of Subjects Diagnosed With Obstruction by Spirometry and Piko-6.
Table 3. Sensitivity, Specificity, Predictive Values, Positive and Negative Odds Ratios for the Detection of Obstruction (FEV1/FVC <0.7 by Spirometry) for Different Cut-off Points for FEV1/FEV6 Measured by Piko-6 and Youden's Index.
Table 4. GOLD Classification of Patients, Depending on FEV1 and FVC Results Obtained Using FS and the Piko-6 Portable Device.
Table 5. Concordance After Diagnosis According to GOLD Classification Determined by FS and Piko-6.
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Abstract
Introduction

COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS.

Methods

FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard.

Results

FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836–0.909), 0.729 (CI 064–0.795) and 0.947 (95% CI 0.928–0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78–0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97.

Conclusions

Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined.

Keywords:
Chronic obstructive pulmonary disease
Underdiagnosis
Spirometry
Piko-6
Resumen
Introducción

La EPOC es una enfermedad de elevada prevalencia pero infradiagnosticada, debido a la escasa implantación de la espirometría forzada (EF) en atención primaria. Los microespirómetros, baratos y de manejo sencillo, que pueden medir FEV6 y FEV1/FEV6, podrían contribuir a reducir el infradiagnóstico. El objetivo del estudio ha sido validar el dispositivo Piko-6 para el cribado de la EPOC, demostrando una buena correlación con la EF convencional.

Métodos

Se han realizado una EF y una determinación con Piko-6 a 155 pacientes susceptibles de padecer EPOC. Se han comparado las correlaciones, curvas ROC e índice de Youden con ambos métodos, considerando la EF como patrón de referencia.

Resultados

Los coeficientes de correlación de FEV1, FVC y FEV6 y los cocientes FEV1/FVC y FEV1/FEV6 fueron de 0,87 (IC 95%: 0,836-0,909), 0,729 (IC 95%: 064-0,795) y 0,947 (IC 95%: 0,928-0,961) respectivamente. La curva ROC para el FEV1 determinado por Piko-6 alcanzó un área bajo la curva de 0,86 (IC 95%: 0,78-0,92). El índice de Youden para el punto de corte de 0,70 del FEV1/FEV6 fue 0,97.

Conclusiones

El Piko-6 puede ser útil para el cribado de la EPOC en atención primaria. Sus determinaciones presentan buena correlación con las obtenidas mediante EF, especialmente el cociente FEV1/FEV6. Esto, junto a su bajo coste y facilidad de uso, puede contribuir a reducir el infradiagnóstico de la EPOC, aunque su rol exacto en el proceso diagnóstico está aún por determinar.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Infradiagnóstico
Espirometría
Piko-6

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