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Vol. 18. Issue 2.
Pages 73-79 (March - April 1982)
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Vol. 18. Issue 2.
Pages 73-79 (March - April 1982)
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Espirograma espiratorio forzado: analisis y valor diagnostico en la obstruccion leve de la via aerea
Evaluation and diagnostic value of forced expiratory spirograms in mild airways obstruction
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S. Romero Candeira, E. Delgado Perez, J. Picher Nuñez, D. Ferrer Marin-Blazquez, J. Jaurena Chury, S. Garcia Rull
Centro Especial «Ramón y Cajal» de la S. S. Servicio de Neumología. Madrid
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Resumen

Se estudió un grupo de 87 sujetos jóvenes considerados sanos, utilizando un sistema automatizado de medida y cálculo, en un intento de determinar los patrones adecuados de normalidad, la influencia del sistema de selección de medida sobre los valores de los flujos máximos y la sensibilidad de los diferentes parámetros del espirograma espiratorio forzado en la discriminación de alteraciones de la pequeña vía debidas al hábito de fumar.

En los 52 sujetos no fumadores, los valores obtenidos para los flujos meso y telespiratorios presentaban discrepancias significativas con los valores de referencia previamente introducidos en el programador.

Los valores promedio de FEV1/FVC, MEF50, FEF25-75, MEF75 y FEF75-85 sirvieron para diferenciar los grupos de fumadores y no fumadores, sin que, en el caso de las mujeres, con una historia de tabaco más corta, las diferencias alcanzaran significación estadística.

Al aplicar a los resultados obtenidos los límites preestablecidos de normalidad no se apreció superioridad valorable de los parámetros mesoespiratorios sobre la relación FEV1/FVC, en cuanto a especificidad ni sensibilidad. La falta de especificidad de los flujos telespiratorios impidió el aprovechamiento de su mayor sensibilidad con fines discriminatorios.

De estos resultados parece deducirse que, en ausencia de líneas de regresión propias, el considerar como anormal a un individuo basándose en un determinado valor de un flujo máximo a bajo volumen pulmonar, es arriesgado, y que la hipotética superioridad de la zona del espirograma espiratorio forzado catalogada como «esfuerzo independiente», en la detección de grados menores de obstrucción de la vía respiratoria, es difícilmente demostrable.

Summary

A group of 87 young apparently healthy individuáis were tested with a computerized measuring and calculating system in an attempt to determine adecuade normal patterns of maximal flow volume, the influence exerted by different test instruments and the sensitivity of torced expiratory spirogram parameters for detecting small airways alterations in cigarette smokers. Of the 87 individuáis taking part in the study, 52 were non-smokers and the remaining 35 smokers. A significant difference was seen between the pre-established reference valúes and médium flow and tele-expiration valúes in the group of non-smokers.

Mean valúes of FEV1/FVC, MEF50, FEF25-75, MEF75 and FEF75-85 were different for smokers and non-smokers, although the valúes for women were not statistically different, presumably because the women had been smoking a shorter time than the men.

When results were compared to the pre-established normal limits, the increase in médium flow parameters over the FEV/FVC relation was so slight as to be immeasurable in either sensitivity or specificity. Although the sensitivity of tele-expiratory flow volumes is high, it was not specific and could not be used for differentiation.

These results suggest that in the absence of proper regression lines a determined maximal flow valué at low pulmonary volume cannot be an indicator of anomalities and the forced expiratory spirogram zone known as «independent effort» zone is not a reliable detector of mild airways obstruction.

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Copyright © 1982. Sociedad Española de Neumología y Cirugía Torácica
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