Spirometry to detect and manage chronic obstructive pulmonary disease and asthma in the primary care setting

Abstract

Most people with chronic obstructive pulmonary disease (COPD) are unaware of the smoldering airway inflammation present in their lungs, which places them at increased risk for premature morbidity and mortality [1-3]. However, COPD is easily detected in its preclinical phase using office spirometry; and successful smoking cessation prevents further disease progression [4]. In the near future, other interventions may also be proven to reduce the rapid decline in lung function experienced by patients with chronic airflow limitation. When patients complain of intermittent cough, wheezing, chest tightness, and shortness of breath, spirometry carried out when the symptoms remain current can often detect the reversible airflow limitation characteristic of asthma. Spirometry also helps to categorise the severity of asthma and confirms response to therapy [5]. Office spirometry is defined as spirometry performed in the primary care (general practitioner) setting. Office spirometry measures the forced expiratory volume in one second (FEV1)/vital capacity (VC) ratio (or surrogates like FEV1/forced vital capacity (FVC) or FEV1/forced expiratory volume in six seconds (FEV6)). This ratio is the most sensitive and specific test for detecting airflow limitation. Spirometry also measures the per cent predicted FEV1, which is the most widely accepted index of the severity of airway obstruction [6, 7]. General practitioners see the majority of adult smokers and patients with asthma, but fewer than half use an office spirometer regularly [8, 9]. Barriers include the perceptions that spirometers are expensive and difficult to use and maintain, that the test disturbs patients and takes too much time to complete, that the reports are too difficult to interpret, and that spirometry testing does not affect clinical outcomes. Improvements in office spirometers Recent improvements in spirometry hardware and software make it less expensive, faster, and easier to obtain good quality spirometry test sessions, with automated interpretations which aid clinical decision-making [10]. Pulmonary specialists and their professional societies can use their knowledge and experience with pulmonary function testing to help general practitioners to select a new office spirometer. Attempts to use older spirometers often lead to frustration and abandonment by primary care practitioners. Volume spirometers are too large, too expensive, risk cross-contamination, and are difficult to maintain in the office setting. Older flow-sensing spirometers may quickly become inaccurate as their sensors become clogged, and many lack quality

COPD in Chinese nonsmokers

“…Each spirometry operator had been well trained, the spirometer was calibrated daily and spirometry results were sent every 2 weeks to Guangzhou for quality control. As reported by ENRIGHT et al [14], a quality grade (A-F) was determined based on acceptable manoeuvres and repeatability of the FEV1 and FVC. Spirometry results with grades A, B or C (at least two acceptable manoeuvres, with FEV1 matching within 0.2 L) were considered acceptable for analysis.…”

Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

“…All commercially employed examiners in study I were also involved in study II. The spirometer was calibrated daily as recommended by Enlight et al (6). To ensure that adequate data were collected from each examinee, all data were carefully checked by 2 authors (K.K.…”

From the author

“…However, 20 yrs ago, the same could have been said of blood pressure measurements, or blood glucose and haemoglobin-A1c measurements for obese and diabetic patients, respectively. I characterise the tone of our chapter in the European Respiratory Monograph [3] as suggesting ''cautious optimism.'' A major goal of our recommendations is to minimise spirometry misclassification rates, which leads to the many caveats in our recommendations.…”