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Underdiagnosis of chronic obstructive pulmonary disease: A MATRIX FOR SPIROMETRY SCREENING? (3)

Recently, Chan et al looked at spirometry use in Ontario and reported a rapid increase in its use due to the diffusion of inexpensive spirometers in physicians’ offices and an increased awareness of guidelines promoting objective testing. However, there was a wide regional variation in spirometry use. A corresponding editorial by Anthonisen suggested that these…

Underdiagnosis of chronic obstructive pulmonary disease: A MATRIX FOR SPIROMETRY SCREENING? (2)

At the same time, the Lung Health Study does not provide a rationale for mass population screening or even for screening in all smokers. Because it was well known that decreased lung function predictive of COPD can be observed in smokers in their 30s, 35 years of age was used as a cut-off point for…

Underdiagnosis of chronic obstructive pulmonary disease: A MATRIX FOR SPIROMETRY SCREENING? (1)

In 1983, the American Thoracic Society issued a position statement discouraging population screening for COPD . There were two main objections. First, it was felt that a positive ‘one-to-one’ correlation between decreased lung function in smokers and future development of COPD had not been adequately shown.

Underdiagnosis of chronic obstructive pulmonary disease: COPD CLINICAL PROFILE (3)

The Lung Health Study used 35 years of age as its lower limit; this choice was justified by the relatively high proportion of patients aged 35 to 39 years (12%) included in the trial. It is possible, however, that COPD is detectable in even younger patients. In a study of tobacco and marijuana smokers with…

Underdiagnosis of chronic obstructive pulmonary disease: COPD CLINICAL PROFILE (2)

The high prevalence of COPD among smokers suggests other possible inclusion criteria for screening, particularly because methacholine reactivity was a strong predictor of decline in lung function in the Lung Health Study . A study by Oxman et al indicated that exposure to occupational dust is a significant risk factor for COPD. Environment may also…

Underdiagnosis of chronic obstructive pulmonary disease: COPD CLINICAL PROFILE (1)

The Lung Health Study showed that spirometry screening in a selected population is an effective way to identify individuals at risk for COPD and to initiate effective interventions. Thus, it seems reasonable to conclude that a clinical profile of asymptomatic COPD can make screening feasible (Table 1).

Underdiagnosis of chronic obstructive pulmonary disease: PREDICTIVE ACCURACY OF SPIROMETRY (3)

Health Study, in which over one-third of the participants were women, baseline FEV1 was found to be a significant predictor of subsequent decline in FEV 1 in both male and female continuing smokers . In the same study, interestingly, methacholine reactivity (although not an appropriate choice as a screening tool) at the start of the…

Underdiagnosis of chronic obstructive pulmonary disease: PREDICTIVE ACCURACY OF SPIROMETRY (2)

The importance of spirometry was demonstrated in a study by van Schayck et al , who evaluated whether the progression of asthma or chronic bronchitis can be predicted by family physicians apart from lung function testing. They compared physical examination and peak flow results with FEV1 as indicators of decline. In chronic bronchitis, only 27%…

Underdiagnosis of chronic obstructive pulmonary disease: PREDICTIVE ACCURACY OF SPIROMETRY (1)

Spirometry is objective and quantifiable, and can detect airflow limitation well before symptoms appear. Although patients with confirmed COPD have a low FEV 1 compared with age-adjusted normal values, this measurement alone may not be predictive of COPD . A more accurate indicator is the ratio of FEV1 to forced vital capacity (FVC).

Underdiagnosis of chronic obstructive pulmonary disease: EFFECTIVENESS OF INTERVENTION (3)

The Lung Health Study also showed the benefit of proactive smoking intervention in patients with mild COPD. The sustained quit rate in the special (active) intervention group over five years was 22% compared with only 5% in the usual care (control) group. According to the investigators, the sustained rate of 22% was among the highest…

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