Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
Original Paper
Med Princ Pract 2007;16:378–383
DOI: 10.1159/000104812
Can Spirometry, Pulse Oximetry and Dyspnea
Scoring Reflect Respiratory Failure in Patients
with Chronic Obstructive Pulmonary Disease
Exacerbation?
Melek Sedef Güryay
a
Emel Ceylan
d
Türkan Günay
b
Sevilay Karaduman
a
Fecri Bengi
a
İsmet Parlak
a
Metin Çiçek
a
Arif H. Cımrın
c
Departments of
a
Emergency Medicine,
b
Public Health and
c
Chest Diseases, Faculty of Medicine, Dokuz Eylül
University, İzmіr , and
d
Department of Chest Diseases, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
respectively) while dyspnea scoring was the most sensitive
(93.5%). In the evaluation by means of an ROC curve, a satu-
ration of 88.5% for the pulse oximeter was the best cutoff
value to reflect hypoxemia (sensitivity 95.6%, specificity
80.6%). Conclusion: SpO
2
alone appears to be as highly spe-
cific as a combination of other tests in the evaluation of
hypoxemia. A cutoff value for SpO
2
of ^ 88.5% is proposed
as a criterion in screening for hypoxemia.
Copyright © 2007 S. Karger AG, Basel
Introduction
According to a report of the World Health Organiza-
tion, chronic obstructive pulmonary disease (COPD) was
the sixth leading cause of death in the world, and it is es-
timated that by the year 2020, COPD will be the third
leading cause of death and the fifth leading cause of
disability worldwide [1, 2]. Moreover, approximately
10% of all hospitalizations are attributable to COPD
[3]. The mortality risk for acute exacerbations of COPD
(AECOPD) has been shown to be about 8 and 23%, re-
spectively, in hospital and 1 year after discharge in a pro-
spective study [4] .
Patients with COPD exacerbations are frequently re-
ferred to the emergency department (ED), but during the
Key Words
Chronic obstructive pulmonary disease Respiratory
failure Pulse oximetry Dyspnea scoring Spirometry
Abstract
Objective: To evaluate the extent to which oximetry, spi-
rometry and dyspnea scoring can reflect hypoxemia and
hypercapnia among patients admitted to the emergency
department (ED) with acute exacerbations of chronic ob-
structive pulmonary disease. Subjects and Methods: Spi-
rometry, oxygen saturation by pulse oximetry (SpO
2
), arte-
rial blood gas analysis and dyspnea scoring assessments
were made in the ED. Correlations of these parameters were
evaluated by means of Pearson’s test. Pulse oximetry cutoff
values to express hypoxemia were demonstrated by receiver
operating characteristic (ROC) curves. Results: 76 patients
with a mean age of 68.0 years were included in the study.
Mean spirometric values, expressed as percentages of pre-
dicted values, were forced expiratory volume in 1 s (FEV
1
) =
23.1 8 9%; forced vital capacity (FVC) = 32.8 8 11%, and
mean FEV
1
/FVC = 72.4 8 21.6%. While there was a positive
correlation between the SpO
2
, SaO
2
and PaO
2
values (r = 0.91
and 0.80, respectively), a negative correlation (r = –0.74) was
observed between PaCO
2
and SpO
2
. In determining hypox-
emia, both SpO
2
and FEV
1
were sensitive (83.9 and 90.3%,
Received: June 18, 2006
Revised: October 14, 2006
Dr. Emel Ceylan
Cumhuriyet mah. 1962 sok. No: 30/4
TR–09020 Aydin (Turkey)
Tel. +90 256 214 9974, Fax +90 256 214 6495
E-Mail emel_ceylan@yahoo.com
© 2007 S. Karger AG, Basel
1011–7571/07/0165–0378$23.50/0
Accessible online at:
www.karger.com/mpp