A systematic review of the accuracy of microspirometry for screening of adults for COPD

Background: COPD is universally underdiagnosed due to lack of availability of spirometry.A microspirometer is a handheld, portable device that uses the FEV1/FEV6 ratio to screen for COPD. Aim: To evaluate the accuracy of microspirometry, when used as a screening tool for COPD among adults. Methods: A systematic search was conducted on Medline, EMBASE, Web of Science, Biosys Preview and Cochrane Central for studies which used a microspirometer for COPD screening in adults. We included studies that employed spirometry as a reference standard. Studies were reviewed by two independent reviewers. Results: A total of 2639 studies were extracted, of which 11 studies met the review criteria.7 studies used targeted screening of smokers. Devices used included Vitalograph COPD-6, Piko-6 and Hichecker vitalograph, with varying device FEV1/FEV6 thresholds for screening (Fig 1).More than 4000 participants were included in the analysis.8 studies were carried out in the primary care setting and 3 were carried out in tertiary care.7 studies were carried out in conjunction with questionnaires. The pooled sensitivity and specificity of microspirometers to diagnose COPD was 87%(95%CI 79,93) and 79%(95%CI 61,90)respectively. Conclusion: Microspirometers are sensitive tools for screening adults for COPD.Higher cutoff values of FEV1/FEV6 were associated with increased sensitivity, as were strategies targeting smokers and a concomitant use of screening questionnaires.