Volumetric capnography and chronic obstructive pulmonary disease staging

Pablo V Romero¹, Benigno Rodriguez¹, Daniela de Oliveira¹, L Blanch², Federico Manresa¹

¹Laboratorio de Función Pulmonar, Servicio de Neumologia, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; ²Critical Care Center, Hospital de Sabadell, Institut Universitari Fundació Parc Taulí, Sabadell, Spain

Abstract: Spirometry is difficult for some COPD patient to perform. Volumetric capnography could be a second choice test to evaluate the severity of functional disturbances. The aim of this work is to test this hypothesis. A total number of 98 subjects were classified either as normal ex-smokers (N = 14) or COPD patients. The latter were staged following GOLD recommendations. Spirometry and volumetric capnography recordings were obtained from each patient. Spirometry parameters, Bohr Dead Space (V_D ^Bohr), Airways Dead Space from the pre-interface expirate corrected curve (V_D ^aw), Phase III slope (Sl_III) and Volume of alveolar ejection (V_AE) were measured. Index of Ventilatory Efficiency (IVE), and Index of Airways Heterogeneity (IAH) were calculated as: IVE = V_AE/(V_T – V_D ^aw) and IAH = 1 – [(V_T – V_D ^Bohr)/(V_T – V_D ^aw)]. In ANOCOVA analysis IAH showed the greatest association with stage (F > 40), with no significant covariant dependence on V_T. A receiver operating characteristics curve analysis showed values of the area under the curve greater than 0.9 for IAH and IVE at all stage levels, with a sensitivity = specificity value greater than 80%. We conclude that IAH and IVE can be used when spirometry cannot be reliably performed, as an alternative test to evaluate the degree of functional involvement in COPD patients.

Keywords: capnography, chronic obstructive pulmonary disease, dead space, pulmonary heterogeneity, receiver operating characteristics curve, spirometry