Prognostic value of FEV1/FEV6 in elderly people

Clin Physiol Funct Imaging. 2011 Mar;31(2):101-7. doi: 10.1111/j.1475-097X.2010.00984.x. Epub 2010 Oct 24.


Background: The ratio of forced expiratory volume in 1 s and forced expiratory volume in 6 s (FEV1/FEV6) has been proposed as an alternative for FEV1/forced vital capacity (FVC) to diagnose obstructive diseases with less effort during spirometry; however, its prognostic value is unknown. We evaluated whether FEV1/FEV6 is a significant predictor of mortality in elderly subjects and compared its prognostic value with that of FEV1/FVC and FEV1.

Methods: One thousand nine hundred and seventy-one subjects, aged >65 years, participated in the population-based SA.R.A. study. During the baseline exam, a multidimensional assessment included spirometry. Vital status was determined during 6 years of follow-up. Association of all-cause, cardio-pulmonary (CP) and non-CP mortality with a low FEV1/FEV6, FEV1/FVC and FEV1 was evaluated.

Results: Among subjects with both survival data and acceptable spirometry including FEV6, all-cause unadjusted mortality rates were 7·00 and 2·46 per 100 person-years in subjects with FEV1/FEV6 less than and greater than or equal to lower limit of normal (LLN), respectively (mortality rate ratio: 2·84, 95%CI: 2·12-3·84). After adjustment for age, gender, FVC, smoke exposure and main comorbidities, the risk of all-cause mortality remained significantly increased in subjects with FEV1/FEV6<LLN [hazard ratio (HR): 1·87, 95%CI: 1·35-2·58] as well as in subjects with FEV1/FVC<LLN (HR: 2·01, 95%CI: 1·51-2·90) and FEV1<LLN (HR: 2·17, 95%CI: 1·32-3·57). Similar results were found for CP mortality, but not for non-CP mortality.

Conclusions: A low FEV1/FEV6 is a significant predictor of mortality in older individuals. Its prognostic value is comparable to that of a low FEV1/FVC and FEV1.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology*
  • Cause of Death
  • Chi-Square Distribution
  • Female
  • Forced Expiratory Volume*
  • Geriatric Assessment / methods*
  • Humans
  • Italy
  • Kaplan-Meier Estimate
  • Lung / physiopathology*
  • Lung Diseases / mortality
  • Lung Diseases / physiopathology*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Spirometry*
  • Survival Rate
  • Time Factors
  • Vital Capacity