Background: Chronic obstructive pulmonary disease (COPD) is a frequent but underdiagnosed disease, primarily due to the lack of access to forced spirometry (FS) in primary care. Portable, easy-to-use expiratory flow meters like Piko-6^® and COPD-6^® that measure FEV₁, FEV₆, and FEV₁/FEV₆ ratio provide an alternative. Given that Piko-6^® and COPD-6^® devices measure FEV₆ but not FVC, the aim of the study is to determine the optimal cutoff value for the FEV₁/FEV₆ ratio of each device to avoid false negatives when these devices are used for COPD screening in primary care (PC). Methods: A total of 664 patients of 35 years of age or older with a cumulative tobacco consumption of 10 or more packs/year were recruited at two university hospitals. FS (gold standard) was performed and FEV₁, FVC, and FEV₁/FVC measurements were compared with FEV₁, FEV₆, and FEV₁/FEV₆ measurements acquired using Piko-6^® and COPD-6^® devices. The devices were compared using statistical methods including Pearson correlation coefficients, the Youden index (YI), kappa coefficient, Bland–Altman plots, and ROC curves analysis. Results: Correlations between FEV₁/FEV₆ using Piko-6^® and COPD-6^® and FEV₁/FVC with FS were 0.79 and 0.73, respectively. Piko-6^® achieved the best YI in FEV₁/FEV₆ (0.73), whereas for COPD-6^®, it was 0.80. Concordance between Piko-6^® and FS was 83.9% (kappa 0.67 ± 0.028) and for COPD-6^®, it was 68.7% (kappa 0.42 ± 0.02). Conclusions: This is the first study that compares two hand-held expiratory flow meters with FS. Piko-6^® and COPD-6^® devices are effective tools for COPD detection, as their measurements provide a good correlation with FS. In order to avoid false negative results, the FEV₁/FEV₆ cutoff point needs to be increased to 0.73 and 0.80 with Piko-6^® and COPD-6^®, respectively.

Background/Objectives: Recent advances in the treatment of non-small cell lung cancer (NSCLC) have shifted from conventional chemotherapy to targeted therapies aimed at specific genetic mutations, particularly in the adenocarcinoma subtype. These therapies have improved overall survival and quality of life. However, some patients still face barriers to accessing these treatments due to challenges in diagnosing advanced-stage NSCLC. Limited tumor cellularity in small biopsies and cytological samples hinders the ability to perform further molecular analyses. Additionally, the increasing number of genetic alterations requiring testing complicates the diagnostic process. To overcome this challenge, we propose combining endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with next-generation sequencing (NGS) and immunohistochemistry for PD-L1. Methods: A total of 120 EBUS-TBNA samples were consecutively collected during the first year of integrating NGS at a reference hospital in Castilla y León, Spain. Depending on the histology and patient characteristics, a total of 67 NGS analyses and 116 PD-L1 determinations were performed. Results: The cytological sample obtained in these cases successfully achieved the triple objective proposed by the NCCN for lung cancer (diagnosis, staging, and molecular analysis in a single procedure) in 97% of instances. Conclusions: Our study highlights the effectiveness of EBUS-TBNA as a comprehensive, cost-effective, and safe diagnostic tool for NSCLC, successfully achieving the triple objective of diagnosis, staging, and molecular analysis in 97% of cases. The procedure consistently provided high-quality samples for NGS and PD-L1 testing, with minimal complications, reinforcing its value as a reliable approach for optimizing personalized treatment strategies.