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The Efficiency Index (EFFi), based on volumetric capnography, may allow for simple diagnosis and grading of COPD

Authors Jarenbäck L, Tufvesson E, Ankerst J, Bjermer L, Jonson B

Received 2 January 2018

Accepted for publication 27 March 2018

Published 27 June 2018 Volume 2018:13 Pages 2033—2039

DOI https://doi.org/10.2147/COPD.S161345

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Linnea Jarenbäck,1 Ellen Tufvesson,1 Jaro Ankerst,1 Leif Bjermer,1 Björn Jonson2

1Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden; 2Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden

Background: Spirometry, the main tool for diagnosis and follow-up of COPD, incompletely describes the disease. Based on volumetric capnography (VCap), an index was developed for the diagnosis and grading of COPD, aimed as a complement or alternative to spirometry.
Methods: Nine non-smokers, 10 smokers/former smokers without COPD and 54 smokers/former smokers with COPD were included in the study. Multiple breath washout of N2 and VCap were studied with Exhalyzer D during tidal breathing. VCap was based on signals for flow rate and CO2 and was recorded during one breath preceding N2 washout. Efficiency Index (EFFi) is the quotient between exhaled CO2 volume and the hypothetical CO2 volume exhaled from a completely homogeneous lung over a volume interval equal to 15% of predicted total lung capacity.
Results: EFFi increased with increased Global initiative for chronic Obstructive Lung Disease (GOLD) stage and the majority of subjects in GOLD 2 and all subjects in GOLD 3 and 4 could be diagnosed as having COPD using the lower 95% confidence interval of the healthy group. EFFi also correlated with N2 washout (r=–0.73; p<0.001), forced expiratory volume in 1 second (r=0.70; p<0.001) and diffusion capacity for carbon oxide (r=0.69; p<0.001).
Conclusion: EFFi measures efficiency of tidal CO2 elimination that is limited by inhomogeneity of peripheral lung function. EFFi allows diagnosis and grading of COPD and, together with FEV1, may explain limitation of physical performance. EFFi offers a simple, effortless and cost-effective complement to spirometry and might serve as an alternative in certain situations.

Keywords: chronic obstructive pulmonary disease, volumetric capnography, carbon dioxide, single breath

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