BMJ Open Respiratory Research (Jul 2025)

Concordance between FVC and FEV6 for identifying chronic airflow obstruction and spirometric restriction in the Burden of Obstructive Lung Disease (BOLD) study

  • ,
  • Andre F S Amaral,
  • Andrzej Pająk,
  • Thorarinn Gislason,
  • Rain Jogi,
  • Emiel Wouters,
  • Cosetta Minelli,
  • Abdul Rashid,
  • Christine Jenkins,
  • Fiona McLean,
  • James Potts,
  • Tobias Welte,
  • Paul Cullinan,
  • Frits M E Franssen,
  • Dali Wang,
  • Eric Bateman,
  • Wen Wang,
  • Kevin Mortimer,
  • Christer Janson,
  • Nanshan Zhong,
  • João Cardoso,
  • Eric D Bateman,
  • Parvaiz A Koul,
  • André FS Amaral,
  • Vanessa Garcia-Larsen,
  • Jamie Rylance,
  • Eli Nordeide,
  • Rune Nielsen,
  • David Mannino,
  • Graham Devereux,
  • Karl Peter Sylvester,
  • Andrei Malinovschi,
  • Sanjay Juvekar,
  • Berik Emilov,
  • Bertrand Mbatchou,
  • Padukudru Anand Mahesh,
  • Kate Hardaker,
  • EFM Wouters,
  • Imed Harrabi,
  • Amund Gulsvik,
  • Sundeep Salvi,
  • Muhammad Irfan,
  • Bill Brashier,
  • Inga Sif Ólafsdóttir,
  • Emmanouil Bagkeris,
  • Zouhair Tabka,
  • Jaymini Patel,
  • Filip Mejza,
  • David M Mannino,
  • Meriam Denguezli,
  • Mohammed Al Ghobain,
  • Daniel O Obaseki,
  • Michael Studnicka,
  • Althea Aquart-Stewart,
  • Parvaiz Koul,
  • Herve Lawin,
  • Asaad Ahmed Nafees,
  • Olayemi Awopeju,
  • Gregory E Erhabor,
  • Louisa Gnatiuc,
  • Ali Kocabas,
  • Cristina Barbara,
  • Hasan Hafizi,
  • Anila Aliko,
  • Donika Bardhi,
  • Holta Tafa,
  • Natasha Thanasi,
  • Arian Mezini,
  • Alma Teferici,
  • Dafina Todri,
  • Jolanda Nikolla,
  • Rezarta Kazasi,
  • Hamid Hacene Cherkaski,
  • Amira Bengrait,
  • Tabarek Haddad,
  • Ibtissem Zgaoula,
  • Maamar Ghit,
  • Abdelhamid Roubhia,
  • Soumaya Boudra,
  • Feryal Atoui,
  • Randa Yakoubi,
  • Rachid Benali,
  • Abdelghani Bencheikh,
  • Nadia Ait-Khaled,
  • Guy Marks,
  • Tessa Bird,
  • Paola Espinel,
  • Brett Toelle,
  • Torkil Dawes,
  • Bernd Lamprecht,
  • Lea Schirhofer,
  • Arsene Kpangon,
  • Karl Kpossou,
  • Gildas Agodokpessi,
  • Paul Ayelo,
  • Benjamin Fayomi,
  • Atongno Humphrey Ashu,
  • Wan C Tan,
  • Shengming Liu,
  • Jiachun Lu,
  • Pixin Ran,
  • Yumin Zhou,
  • Hendrik Laja,
  • Katrin Ulst,
  • Vappu Zobel,
  • Toomas-Julius Lill,
  • Isabelle Bodemann,
  • Henning Geldmacher,
  • Alexandra Schweda-Linow,
  • Bryndis Benedikdtsdottir,
  • Kristin Jörundsdottir,
  • Lovisa Gudmundsdottir,
  • Sigrun Gudmundsdottir,
  • Sajjad Malik,
  • Nissar A Hakim,
  • Umar Hafiz Khan,
  • Rohini Chowgule,
  • Vasant Shetye,
  • Jonelle Raphael,
  • Rosel Almeda,
  • Mahesh Tawde,
  • Rafiq Tadvi,
  • Sunil Katkar,
  • Milind Kadam,
  • Rupesh Dhanawade,
  • Umesh Ghurup,
  • Siddhi Hirve,
  • Somnath Sambhudas,
  • Bharat Chaidhary,
  • Meera Tambe,
  • Savita Pingale,
  • Arati Umap,
  • Archana Umap,
  • Nitin Shelar,
  • Sampada Devchakke,
  • Sharda Chaudhary,
  • Suvarna Bondre,
  • Savita Walke,
  • Ashleshsa Gawhane,
  • Anil Sapkal,
  • Rupali Argade,
  • Vijay Gaikwad,
  • Jyoti Londhe,
  • Sapna Madas,
  • Akosua Francia Aikman,
  • Talant M Sooronbaev,
  • Bermet M Estebesova,
  • Meerim Akmatalieva,
  • Saadat Usenbaeva,
  • Jypara Kydyrova,
  • Eliza Bostonova,
  • Ulan Sheraliev,
  • Nuridin Marajapov,
  • Nurgul Toktogulova,
  • Toktogul Azilova,
  • Gulnara Beishekeeva,
  • Nasyikat Dononbaeva,
  • Aijamal Tabyshova,
  • Wezzie Nyapigoti,
  • Ernest Mwangoka,
  • Mayamiko Kambwili,
  • Martha Chipeta,
  • Gloria Banda,
  • Suzgo Mkandawire,
  • Justice Banda,
  • Li-Cher Loh,
  • Siti Sholehah,
  • Mohamed C Benjelloun,
  • Chakib Nejjari,
  • Mohamed Elbiaze,
  • Karima El Rhazi,
  • Daniel Obaseki,
  • Gregory Erhabor,
  • Olufemi Adewole,
  • Tina Endresen,
  • Lene Svendsen,
  • Asaad A Nafees,
  • Luisito F Idolor,
  • Norberto A Francisco,
  • Camilo C Roa,
  • Fernando G Ayuyao,
  • Cecil Z Tady,
  • Daniel T Tan,
  • Sylvia Banal-Yang,
  • Vincent M Balanag,
  • Renato B Dantes,
  • Lourdes Amarillo,
  • Lakan U Berratio,
  • Lenora C Fernandez,
  • Gerard S Garcia,
  • Thessa Reyes,
  • Ma Flordeliza Sanchez,
  • Leander P Simpao,
  • Jakub Frey,
  • Rafal Harat,
  • Pawel Nastalek,
  • Wojciech Skucha,
  • Andrzej Szczeklik,
  • Magda Twardowska,
  • Fátima Rodrigues,
  • Hermínia Dias,
  • João Almeida,
  • Maria João Matos,
  • Paula Simão,
  • Moutinho Santos,
  • Reis Ferreira,
  • M Al Ghobain,
  • H Alorainy,
  • E El-Hamad,
  • A Hashi,
  • R Dela,
  • R Fanuncio,
  • E Doloriel,
  • I Marciano,
  • Anamika Jithoo,
  • Desiree Adams,
  • Edward Barnes,
  • Jasper Freeman,
  • Anton Hayes,
  • Sipho Hlengwa,
  • Christine Johannisen,
  • Mariana Koopman,
  • Innocentia Louw,
  • Ina Ludick,
  • Alta Olckers,
  • Johanna Ryck,
  • Janita Storbeck,
  • Kirthi Gunasekera,
  • Rajitha Wickremasinghe,
  • Asma Elsony,
  • Hana A Elsadig,
  • Nada Bakery Osman,
  • Bandar Salah Noory,
  • Monjda Awad Mohamed,
  • Suhaiba Khalifa,
  • Mahmoud Elhadi,
  • Mohand Hassan,
  • Dalia Abdelmonam,
  • Katarina Nisser,
  • Gunilla Hägg,
  • Gun-Marie Lund,
  • Terence Seemungal,
  • Fallon Lutchmansingh,
  • Liane Conyette,
  • Myriam Denguezli,
  • Hager Daldoul,
  • Zaki Boukheroufa,
  • Firas Chouikha,
  • Wahbi Belhaj Khalifa,
  • Attila Hancioglu,
  • Ismail Hanta,
  • Sedat Kuleci,
  • Ahmet Sinan Turkyilmaz,
  • Sema Umut,
  • Turgay Unalan,
  • Peter GJ Burney,
  • Hadia Azar,
  • Caron Amor,
  • Michael Tumilty,
  • Risha Dudhaiya,
  • A Sonia Buist,
  • Mary Ann McBurnie,
  • William M Vollmer,
  • Suzanne Gillespie,
  • Sean Sullivan,
  • Todd A Lee,
  • Kevin B Weiss,
  • Robert L Jensen,
  • Robert Crapo,
  • Paul Enright,
  • John Cain,
  • Rebecca Copeland,
  • Dana Hazen,
  • Jennifer Methvin,
  • Rana Ahmed,
  • Marta Erdal,
  • G J Wesseling,
  • Ewa Niżankowska-mogilnicka,
  • Sullian S Naval,
  • Ulrike Spetz-Nyström,
  • Jin-Ping Zheng,
  • Gunnar Gudmundsson,
  • Ben Knox-Brown,
  • Octavia Mulhern,
  • Dhiraj Agarwal,
  • Rashid Osman,
  • M Al Hajjaj,
  • L Safia,
  • Abdel Mu‘is ElZain,
  • Marwa Mohamed Mohamaden,
  • Dhiraj Agrawal,
  • Sanjay K Juvekar,
  • Stefanni Nonna M Paraguas,
  • Elin Helga Thorarinsdottir,
  • Hasan Nawaz Tahir,
  • Anders Ørskov Rotevatn,
  • MariaTeresita N Reyes,
  • Rolus Atrokpo,
  • Gaston Hounton,
  • Dieudonnè Yadjodo,
  • Katrin Kiili,
  • Ira Laanelepp,
  • Hjördis Sigrun Pálsdottir,
  • Mahesh Padukudru Anand,
  • Babu Pawar,
  • Shalan Mhetre,
  • Namdev Kale,
  • Shirish Kathale,
  • Martin Njoroge,
  • Catherine Chirwa,
  • Chifundo Mhango,
  • Edgar Ngwira,
  • Faith Zumazuma,
  • Frank Jonas,
  • Patrick Mjojo,
  • Manelle Rjimati,
  • Btissame ElHarche,
  • Reda Benjelloun,
  • Yassin Chefchaou,
  • Marit Aardal,
  • Hildegunn B Fleten,
  • Gerd Eli Dale,
  • Malin P Grøttveit,
  • Åsa Skjelde,
  • Ane Aamli Gagnat,
  • Muhammad Noman,
  • Roman Ul Haq,
  • Teresita S deGuia,
  • Stefanni Nonna MParaguas,
  • Richard vanZyl-Smit,
  • Hasab Alrasoul AkashaAhmedOsman,
  • Namarig Moham edElhassan,
  • Hind Eltigani,
  • Najlaa Mohamed Abass,
  • Ahmed Beriar Ahmed,
  • Sahar AlaElddin,
  • Eva Wallberg,
  • Birgitta Appelfeldt,
  • Mona Andrén,
  • Safa Hsan,
  • Nadia Lakhdar,
  • Mounir Landolsi,
  • Jasleen Gegic,
  • Vanessa Garcia Larsen

DOI
https://doi.org/10.1136/bmjresp-2024-002355
Journal volume & issue
Vol. 12, no. 1

Abstract

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Introduction We investigated whether the forced expiratory volume in 6 s (FEV6) can be used as a surrogate for the forced vital capacity (FVC).Methods The Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults, aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed-up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV1/FEV6 less than the lower limit of normal (LLN) to correctly classify FEV1/FVC less than the LLN, and FEV6 less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life and lung function decline.Results At baseline, 28 604 participants were included. 53% were female (15 060). 10% (2876) had chronic airflow obstruction for FEV1/FVC, compared with 9% (2704) for FEV1/FEV6. 37% (10 637) had spirometric restriction for FVC, compared with 35% (9978) for FEV6. The FEV1/FEV6 had excellent accuracy in identifying FEV1/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV6 also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV1/FEV6 (1%, 345) and FEV6 (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up. Those with discordant reductions in FEV1/FEV6 and FEV6 were more likely to have chronic airflow obstruction and spirometric restriction at follow-up.Conclusions There is strong agreement between the FVC and FEV6 in the identification of chronic airflow obstruction and spirometric restriction.