Anupam K. Singh

FEV1/FEV6: A Reliable, Easy-to-Use, and Cheaper Alternative to FEV1/FVC in Diagnosing Airway Obstruction in Indian Population

Background. FEV1/FEV6 has been proposed as a cheap, reproducible and valid alternative to FEV1/FVC in spirometry. No Indian data exists on its utility to diagnose airway obstruction. Aim. we sought to determine a fixed cut off of FEV1/FEV6 to diagnose obstruction corresponding to FEV1/FVC < 0.70 proposed by GOLD guidelines. Method. Spirometry was done on patient referred to a tertiary centre in India. Age, sex, height weight were recorded in addition to spirometric variables like FEV1, FVC, FEV6. The sensitivity, specificity, positive and negative predictive values of FEV1/FEV6 were determined with respect to gold standard of FEV1/FVC < 0.70. Results. 467 spirometries were analysed after meeting the ATS acceptability criteria. Considering FEV1/FVC < 0.7 as being the gold standard for obstruction, ROC curve was used to determine the best corresponding cut-off for FEV1/FEV6. The area under the curve was 99.3% (95% CI: 98.1–99.8%), and the FEV1/FEV6 cut-off, corresponding to the greatest sum of sensitivity and specificity, was 73%. For the total population, the FEV1/FEV6 sensitivity, specificity, PPV, NPV were was 95.7 %, 94.2 %, 87.5 % and 97.9 % respectively. Agreement by Kappa value between two cut offs was excellent 0.89 (0.87–0.91). Conclusion. FEV1/FEV6 < 73% is a new reliable spirometry index to diagnose airway obstruction in Indian population.

EVALUATING THE ROLE OF INTRAVENOUS MAGNESIUM SULPHATE AS AN ADJUNCT TO STANDARD THERAPY IN SEVERE ACUTE ASTHMA

Introduction and Objectives: Anemia is a prevalent pathology associated with many chronic diseases. COPD in industrialized countries is one of the pathologies that causes more morbi-mortality, and consumes a great amount of health resources. We selected a group of severe COPD patients that were admitted at our hospital, and determine if the presence of anemia modified the number of hospitalary admissions of these patients. Material and Methods: 85 patients admitted at our service, diagnosed of severe COPD by spirometry during the first three months of 2006 were chosen for our study. We first determine the prevalence of anemia in this group following the OMS criteria for anemia (levels under 13 g/dl for men, and under 12 g/dl for women). We evaluated the mortality rate of patients that had anemia, and compared if this group presented more frequency of hospitalary readmission during the next 12 months. Results: 57 of the 85 patients included were men, and 8 women. 24% (20) had anemia. 6% of patients with anemia died during the study. Hospitalary readmission was 65% in the group of anemia, compared with the ones that didn’t have anemia, 57%. Differrences were statistical significatives (p<0.05). Conclusions: Prevelence of anemia in our study group was 24%, mainly men. Global mortality rate was 14%, and 6% in patients with COPD and anemia. Patients with severe EPOC and anemia needed higher number of readmissions during the following months that continued the study