World Spirometry Day: intention to test should be intention to treat [Editorial]

Abstract

agement of patients with chronic airfl ow limitation in resource-limited settings should also be clarifi ed. Unfortunately, quality-assured essential medicine, such as inhaled corticosteroids and bronchodilators, for patients with airfl ow limitation may not be accessible or affordable in low-and middle-income countries. 5 Even simple diagnostic tools such as peak fl ow meters are usually not available, let alone spirometers, and large numbers of patients in resource-limited settings repeatedly make unplanned health visits due to asthma attacks or exacerbations of chronic obstructive pulmonary disease in the absence of long-term management and care. Intention to treat therefore demands a system-wide approach to address the needs of the vulnerable. The second WSD, on 27 June 2012, will be an opportunity to raise awareness about lung health, although its objectives need to be clarifi ed. While spirometry is recommended for the diagnosis of airfl ow limitation in patients with respiratory symptoms, several professional societies recommend against using it in individuals without respiratory symptoms, as it involves substantial cost and may result in over-diagnosis due to false-positive results, unnecessary disease labelling, and inadequate use of medicine without clear benefi t in reducing future risks of exacerbation and lung function decline. 4 Further, providing individuals with their spirometry results was not found to independently improve smoking cessation or the likelihood of continued abstinence. 4 WSD should therefore aim at raising awareness about lung health, but not at using spirometry screening among asymptomatic individuals. As screening without adequate follow-up care will yield no benefi t, intention to test should be intention to treat.The contribution of WSD in improving the man- Published by The Union (www.theunion.org), PHA provides a platform to fulfi l its mission, 'Health solutions for the poor'. PHA publishes high-quality scientifi c research that provides new knowledge to improve the accessibility, equity, quality and effi ciency of health systems and services.

Impact of active and passive smoking as risk factors for asthma and COPD in women presenting to primary care in Syria: first report by the WHO-GARD survey group

“…The essential tools to diagnose CRD, such as peak-flow meters and spirometry, should be available to PHCs in developing countries 48,49…”