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PubMed1996

Oxygen consumption calculated from the Fick equation has limited utility.

OBJECTIVE: To determine if oxygen consumption (VO2) calculated using the Fick relationship (calculated VO2) determines total body VO2 accurately and precisely enough to employ this method during clinical assessment of oxygen transport. DESIGN: Methods comparison, using repeated measures during four physiologic states: normal heart/normal lungs, heart failure/normal lungs, normal heart/acute lung injury, heart failure/acute lung injury. SETTING: University research laboratory. SUBJECTS: Thirteen adult Yucatan pigs. INTERVENTIONS: Oleic acid-induced acute lung injury; heart failure was induced with a continuous infusion of esmolol. MEASUREMENTS AND MAIN RESULTS: Calculated VO2 was determined by multiplying thermodilution cardiac output by the arterialvenous oxygen content difference in anesthetized, spontaneously breathing animals. Conditions were tightly controlled so that calculated VO2 would be as accurate as possible. "True" VO2 was measured simultaneously with a water-sealed spirometer (spirometry VO2). Calculated VO2 and spirometry VO2 were determined and analyzed during the four physiologic states listed above. Pooled data also were evaluated. Mean spirometry VO2 and calculated VO2 differed significantly during all four physiologic states and when data were pooled (spirometry VO2 273 +/- 70, calculated VO2 178 +/- 58 mL/min; p < .01). Calculated VO2 consistently underestimated spirometry VO2, as demonstrated by the large, positive bias in pooled data (95 +/- 59 mL of oxygen/min) and in the four physiologic states. Linear regression of data from all four states yielded slopes that were indistinguishable from 1, but y intercepts that varied from -152 to +182. For pooled data, the following equation was used: calculated VO2 = 0.5 x (spirometry VO2 + 46); r2 = .35. Precision in pooled data was 22% of the mean spirometry VO2. Data analysis for the four physiologic states demonstrated results similar to those results obtained when data were pooled. CONCLUSIONS: Even in a tightly controlled, clinical simulation in the laboratory, calculated VO2 from the Fick relationship systematically underestimated VO2 measured with a water-sealed spirometer. If true VO2 changes, the magnitude and direction of change will be reflected by calculated VO2 but with approximately 20% error in the absolute value. Heart failure, acute lung injury, and their combination did not affect the accuracy of calculated VO2. Therefore, calculating VO2 using the Fick relationship is too inaccurate to be used for research purposes. Because assessment of the directional change of VO2 may be clinically useful, calculated VO2 can be employed with discretion during clinical oxygen transport evaluation, bearing in mind the calculation's inherent imprecision.

Animals↗
PubMed2006

National survey of spirometer ownership and usage in general practice in Australia.

OBJECTIVES AND BACKGROUND: Despite the lack of data, it is believed that spirometry is underutilized in general practice. The aim of the present study was to determine the availability of spirometry and the level of spirometry training in general practice throughout Australia and compare with international data. METHODS: In total, 5976 general practices throughout Australia were sent a questionnaire requesting details of spirometer ownership, usage and the level and source of spirometry training. To exclude response bias, a follow-up telephone survey was conducted of 160 practices that did not respond to the initial survey. RESULTS: Of practices 19.5% (1125) responded to the initial survey with 64.2% (722) of these owning a spirometer and 83.9% in the follow-up sample. Common reasons for not owning a spirometer were equipment cost (53.3%) and insufficient remuneration (32.8%). Most practices (67.0%) performed one or more tests per week. Practices commonly used spirometry to diagnose (89.5%) and manage (93.9%) asthma, assess breathlessness (83.4%) and to detect and manage other diseases such as COPD (77.7%). Spirometer accuracy was never checked using a syringe 77.8% of practices and 40% did not test a healthy subject as part of their quality assurance programme. Spirometry training was received most commonly through courses run by general practice organizations (38.2%), and the duration of training courses was <2 h in 40% of cases. CONCLUSION: Despite high spirometer ownership in general practice, the frequency of use is low. Low rates of verification of spirometer accuracy and performance suggest the need for reliable, stable spirometers to be available to general practitioners. Regular and more comprehensive training in spirometry is needed.

Australia↗
PubMed1994

Respiratory health screening using pulmonary function tests and lung sound analysis.

Lung sounds (LS) analysis is a potential source of additional objective, noninvasive and quantitative information on the status of the pulmonary system. We have examined the hypothesis that the addition of lung sounds analysis to spirometry increases the sensitivity of objective population screening, as compared to the use of spirometry alone. Questionnaires, spirometry and lung sounds were obtained in 493 active workers. Lung sounds analysis consisted of the averaged power spectra of breath sounds, measured separately during inspiration and expiration at four standard locations over the trachea and the chest-wall. Of the 493 subjects, 91 had an obstructive lung disease, including 27 with chronic bronchitis identified by a history of prolonged cough and sputum production but with normal spirometry. Twelve additional workers had a restrictive lung disease. Abnormal spirometric results were found in 74 of the patients. Abnormal lung sounds analyses were found in 54 patients, including 14 of the chronic bronchitis cases, so that the overall sensitivity of objective screening tests increased from 71% to 87% by combining the two tests. Thirty three of the subjects considered normal by evaluation of their questionnaire and spirometry had abnormal lung sounds. Of the twenty four who were re-evaluated 12-18 months after the first tests, three had developed a lung or heart disease. We conclude that the combination of spirometry and lung sounds analysis significantly increased the sensitivity of detection of pulmonary diseases by objective tests, and provided an early sign of lung disease that was not detected by spirometry alone.

Adult↗
PubMed2004

Validity of the American Thoracic Society and other spirometric algorithms using FVC and forced expiratory volume at 6 s for predicting a reduced total lung capacity.

OBJECTIVES: (1) To compare the performance of three spirometric algorithms developed to predict whether the total lung capacity (TLC) is reduced vs normal or increased, (2) to determine if forced expiratory volume at 6 s (FEV(6)) can be substituted for FVC in these algorithms, and (3) to determine if ascertainment bias was present in patients referred for the measurement of spirometry and TLC compared to patients referred for spirometry only. METHODS: We analyzed the results of 219 consenting consecutive patients referred to a New Zealand tertiary hospital respiratory laboratory for spirometry and TLC measurements. Spirometry results from 370 patients referred for spirometry but not lung volumes were used to test for potential ascertainment bias. Spirometry results were analyzed using the lower limit of normal (LLN) values from the third National Health and Nutrition Examination Study reference equations. The equations of Goldman and Becklake, and Crapo were used to classify TLC as normal or abnormal. Receiver operator characteristic curves were used to produce an algorithm using the LLN for FVC and FEV(6). The performances of previous algorithms and our own algorithms were analyzed for predicting a reduced lung volume against the "gold standard," plethysmographic TLC. RESULTS: All three algorithms predicted a reduced TLC with an accuracy of approximately 50%. In contrast, all algorithms predicted TLC was either normal or increased with an accuracy of > or = 99% regardless of the reference set used. The algorithms based on FEV(6) performed equally as well as the FVC algorithms. No ascertainment bias was found. CONCLUSIONS: This study provides evidence that spirometry-based algorithms can accurately predict when TLC is either normal or increased, and can also increase the a priori probability that TLC is reduced to approximately 50%. FEV(6) is equivalent to FVC in these predictions.

Adult↗
PubMed1999

Chronic respiratory symptoms, von Willebrand factor and longitudinal decline in FEV1.

Although some risk factors for accelerated decline in forced expiratory volume in 1 s (FEV1) such as cigarette smoking, are well defined, it is not possible to identify those individuals with the most rapid rates of decline. Von Willebrand factor (vWF) is a product of both the pulmonary and systemic endothelium, and serum levels are raised during episodes of acute bronchitis. We hypothesized that raised serum levels of vWF may indicate sub-clinical pulmonary injury and so may predict subsequent accelerated decline in FEV1. The aims of this study were 1. to define the prevalence of chronic respiratory symptoms and obstructive airway disease in an inner-city British population and 2. to determine whether elevated levels of von Willebrand factor (vWF) identify those individuals at risk for more rapid decline in FEV1 over time. In 1987, all 2013 individuals aged 45 to 74 years at an inner-city general practice were mailed a respiratory symptom questionnaire. One in six of the responders were asked to attend for spirometry and for assessment of serum vWF. In 1996, those individuals who had spirometry and vWF assessed in 1987 were traced, and repeat spirometry was performed. In 1987, 1527 of 2013 (75.8%) individuals completed the questionnaire. Forty-two point two percent of responders reported shortness of breath on hills, 34.7% reported wheeze and 31.6% reported mucus hypersecretion. Smokers were more likely to report these symptoms. Two hundred and ten of the 251 (84%) individuals approached had spirometry and vWF assessed. Eleven percent of these had both an FEV1 < 75% predicted and a forced expiratory ratio (FEV1 forced vital capacity (FVC)) < 70%. Sub-normal spirometry was associated with wheeze, mucus hypersecretion, cigarette smoking and increasing age. By 1996, 32 (15%) of the original group of 210 individuals had died, and 117 of the remaining 178 (66%) had spirometry repeated. FEV1 < 75% predicted was a strong predictor of interim mortality, independent of age, sex and smoking history. The average decline in FEV1 was 46.7 ml yr-1. There was no significant correlation between serum vWF levels and subsequent decline in FEV1. Chronic respiratory symptoms and spirometric evidence of airflow limitation are common in inner-city residents of the U.K., and are associated with smoking history. Much of this disease is unrecognised by health professionals. An FEV1 < 75% predicted is a strong independent predictor of subsequent mortality. The measurement of serum vWF levels is unhelpful in identifying those individuals at increased risk of accelerated decline in FEV1.

Aged↗
PubMed2000

Internet-based home asthma telemonitoring: can patients handle the technology?

STUDY OBJECTIVE: To evaluate the validity of spirometry self-testing during home telemonitoring and to assess the acceptance of an Internet-based home asthma telemonitoring system by asthma patients. DESIGN: We studied an Internet-based telemonitoring system that collected spirometry data and symptom reports from asthma patients' homes for review by physicians in the medical center's clinical information system. After a 40-min training session, patients completed an electronic diary and performed spirometry testing twice daily on their own from their homes for 3 weeks. A medical professional visited each patient by the end of the third week of monitoring, 10 to 40 min after the patient had performed self-testing, and asked the patient to perform the spirometry test again under his supervision. We evaluated the validity of self-testing and surveyed the patients attitude toward the technology using a standardized questionnaire. SETTING: Telemonitoring was conducted in patients' homes in a low-income inner city area. PATIENTS: Thirty-one consecutive asthma patients without regard to computer experience. MEASUREMENT AND RESULTS: Thirty-one asthma patients completed 3 weeks of monitoring. A paired t test showed no difference between unsupervised and supervised home spirometry self-testing. The variability of FVC (4.1%), FEV(1) (3. 7%), peak expiratory flow (7.9%), and other spirometric indexes in our study was similar to the within-subject variability reported by other researchers. Despite the fact that the majority of the patients (71%) had no computer experience, they indicated that the self-testing was "not complicated at all" or only "slightly complicated." The majority of patients (87.1%) were strongly interested in using home asthma telemonitoring in the future. CONCLUSIONS: Spirometry self-testing by asthma patients during telemonitoring is valid and comparable to those tests collected under the supervision of a trained medical professional. Internet-based home asthma telemonitoring can be successfully implemented in a group of patients with no computer background.

Adult↗
PubMed1984

Early prediction of the need for hospitalization in children with acute asthma.

We studied 133 asthmatic children in the emergency room who were aged 4 to 17 years and who were not receiving ongoing training in pulmonary function testing, to determine whether spirometry correlated with the outcome of the emergency treatment of the acute attack and with relapse during the next four days. A clinical score derived from the physical exam was obtained at the time of spirometry. Patients were hospitalized or discharged home based solely on their clinical response to therapy. The pediatrician making that decision was blinded to the results of the spirometry. The initial pretreatment clinical score or spirometry alone identified the majority of patients hospitalized, but each falsely identified many discharged patients who did not relapse, 20 percent and 15 percent, respectively. Predictive criteria for hospitalization, combining spirometry with a careful clinical evaluation prior to the start of emergency treatment, substantially reduced the number of falsely identified patients. With use of the predictive criteria, the majority of children admitted to the hospital would have been identified hours before that decision was made on clinical grounds alone (5.5 +/- 0.7 hrs). This study suggests a role for spirometry as an adjunct to clinical evaluation in the early identification of the need for hospitalization of acutely ill asthmatic children.

Acute Disease↗
PubMed2005

The influence of pulmonary function testing on the management of asthma in children.

OBJECTIVE: To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone. STUDY DESIGN: Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented. RESULTS: Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy. CONCLUSION: Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.

Adolescent↗
PubMed2004

Factors determining performance of bronchodilator reversibility tests in middle-aged and elderly.

Knowledge of the factors determining the performance of bronchodilator reversibility testing in a general population is lacking. Random samples of all adults aged 47-48 and 71-73 years living in Bergen, Norway, were invited to a cross-sectional study. Altogether 3506 subjects attended (69%). Test quality predictors were examined through multiple logistic regression analyses including gender, age, body mass, educational level, smoking history, respiratory symptoms, and in the elderly cohort cognitive level. Among the participants, 1.6% refused to inhale salbutamol, 2.5% failed the initial spirometry according to the ATS guidelines, and 1.3% failed the post-bronchodilator spirometry. Old age and body mass index > 30 kg/m2 were independent risk factors for an unsuccessful initial spirometry, and never smoking and respiratory symptoms were risk factors for failing the post-bronchodilator spirometry. Cognitive impairment in the elderly was a risk factor for failing both the initial- and post-bronchodilator spirometry. The median number of forced expirations was 7 in subjects obtaining an acceptable reversibility test. One third of these participants needed > or = 8 attempts, with independent predicting factors being old age, Little formal education and never smoking. Although reversibility testing becomes increasingly difficult with age, reliable data are obtained in a vast majority (94%) of subjects in our community study.

Adrenergic beta-Agonists↗
PubMed1999

Estimating effectiveness in an observational study: a case study of dornase alfa in cystic fibrosis. The Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis.

Patients with cystic fibrosis (CF) receiving dornase-alfa had improved pulmonary function relative to a control group in a large randomized phase III controlled study. We reviewed data from a large observational phase IV study to estimate the observed drug effect in patients receiving dornase alfa as part of their routine care. Patients 6 years or older and with a baseline forced expiratory volume in 1 second (FEV1) of at least 40% predicted who had been enrolled for at least 18 months were included (n = 283). The control group consisted of 2382 patients who had never received dornase alfa. Patients in the study had a baseline spirometry and a second spirometry recorded 12 months later; a baseline observation period of 6 months preceded the initial spirometry, and dornase alfa had to have been started after the baseline spirometry (within 3 months) and to have continued through the 12-month follow-up spirometry. Patients treated with dornase alfa had lower pulmonary functions, more bacterial colonization, and more exacerbations at baseline (FEV1 : 76.0% vs 87.6%, Pseudomonas aeruginosa : 64.1% vs 46.7%, pulmonary exacerbations during the previous 6 months: 56.4% vs 22. 2%). Mean values of FEV1 for patients treated with dornase alfa improved by 3.9% of predicted compared with a decline of 1.6% in the untreated cohort. Covariate adjustment provided an estimated benefit of dornase alfa of 4.3% predicted FEV1 (SE = 0.9, P <.0001). This analysis provides evidence for the effectiveness of dornase alfa therapy in clinical practice.

Child↗
PubMed2004

Should general practitioners screen smokers for COPD?

OBJECTIVE: To discuss whether screening for early chronic obstructive lung disease (COPD) is justifiable. BACKGROUND: The COPD diagnosis can usually be made by means of spirometry before symptoms appear. General practitioners are these days encouraged, from several quarters, to screen their smoking patients for early COPD. Smoking cessation is still the only available treatment that indisputably improves the long-term prognosis of this disease. The argument for screening is that people will be more easily motivated to stop smoking if they know their lung function results. There is, however, no documentation that this is the case. DATA SOURCES: Pub Med using the search terms "mass screening", "COPD" and "spirometry". RESULTS: There is no evidence today that spirometry screening aids smoking cessation. CONCLUSIONS: A large randomized study is needed, in which the independent effect of spirometry as part of a smoking cessation programme is studied. Until such a study has shown convincing results, and has been followed by a cost-benefit analysis in favour of screening, screening for pre-clinical COPD in general practice should not be recommended. However, it is important to diagnose people who may benefit from symptom-relieving treatment, and therefore patients with smoking-related symptoms should be offered spirometry. Finally, the general practitioner should strive to offer smoking cessation counselling to all smokers, regardless of their lung function.

Cost-Benefit Analysis↗
PubMed2004

Evaluation of chest motion and volumetry during the breathing cycle by dynamic MRI in healthy subjects: comparison with pulmonary function tests.

RATIONALE AND OBJECTIVES: To investigate diaphragm and chest wall motion during the whole breathing cycle using magnetic resonance imaging (MRI) and a volumetric model in correlation with spirometry. MATERIALS AND METHODS: Breathing cycles of 15 healthy volunteers were examined using a trueFISP sequence (5 slices in 3 planes, 3 images per second). Time-distance curves were calculated and correlated to spirometry. A model for vital capacity (VC), continuous time-dependent vital capacity (tVC), and investigating the influence of horizontal and vertical parameters on tVC was introduced. RESULTS: Time-distance curves of the breathing cycle using MRI correlated highly significant with spirometry (P < 0.0001). VC calculated by the model was similar to VC measured in spirometry (5.00 L vs. 5.15 L). tVC correlated highly significantly with spirometry (P < 0.0001). Vertical parameters had a more profound influence on tVC change than horizontal parameters. CONCLUSIONS: Dynamic MRI is a simple noninvasive method to evaluate local chest wall motion and respiratory mechanics. It widens the repertoire of tools for lung examination with a high temporal resolution.

Adult↗
PubMed1996

Prevention of respiratory complications after abdominal surgery: a randomised clinical trial.

OBJECTIVE: To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients. DESIGN: Stratified randomised trial. SETTING: General surgical service of an urban teaching hospital. PATIENTS: 456 patients undergoing abdominal surgery. Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk. OUTCOME MEASURES: Respiratory complications were defined as clinical features consistent with collapse or consolidation, a temperature above 38 degrees C, plus either confirmatory chest radiology or positive results on sputum microbiology. We also recorded the time that staff devoted to prophylactic respiratory therapy. RESULTS: There was good baseline equivalence between the groups. The incidence of respiratory complications was 15% (35/231) for patients in the incentive spirometry group and 12% (28/225) for patients in the mixed therapy group (P = 0.40; 95% confidence interval -3.6% to 9.0%). It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients. The inclusion of physiotherapy for high risk patients, however, resulted in the utilisation of an extra 30 minutes of staff time per patient. CONCLUSIONS: When the use of resources is taken into account, the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients.

Abdomen↗
PubMed2002

Internet-based home monitoring of pulmonary function after lung transplantation.

Home monitoring of spirometry has been advocated in lung transplant recipients for the early detection of acute infection and rejection of the allograft. We have developed a user-friendly, Internet-based telemonitoring system providing direct transmission of home spirometry to the hospital. In this prospective study, we assessed patient adherence with the monitoring, agreement between home and hospital spirometry, intrasubject coefficient of variation (CV) for FEV(1) and FEF(25-75), and sensitivity of these variables for the detection of acute complications. Twenty-two bilateral-lung and heart-lung transplant recipients were followed for a median of 473 d (range, 60-822), during which 13,833 measurements were obtained. Patient compliance was 55% for two measurements a day and 84% for one measurement a day. Agreement between home and hospital spirometry was within 4% for FEV(1) and 6% for FEF(25-75). Mean CV was 3.2% for FEV(1) and 7.5% for FEF(25-75). Using transbronchial lung biopsy and/or bronchoalveolar lavage as gold standards, the sensitivity of home spirometry was 63%, and 23% of true positives were detected by changes in FEF(25-75) alone. We conclude that home monitoring of pulmonary function in lung transplant recipients via the Internet is feasible and provides very reproducible data; yet it has only a mild sensitivity for the detection of acute allograft dysfunction.

Adult↗
PubMed2003

Evaluation of ventilation maldistribution as an early indicator of lung disease in children with cystic fibrosis.

Many children with cystic fibrosis (CF), receiving modern, aggressive CF care, have normal spirometry results. This study aimed to see if homogeneity of ventilation distribution is impaired early in the course of CF lung disease, and if ventilation inhomogeneity is a more frequent finding than abnormal spirometry in children benefiting from modern CF care. The study compared spirometry findings to two indices of ventilation inhomogeneity (mixing ratio (MR) and lung clearance index (LCI)) from multiple-breath inert gas washout in 43 children with CF, aged 3-18 yrs, and 28 healthy children. In total, 10/43 CF subjects (23%) had reduced forced expiratory volume in one second (FEV1) and 14/34 (41%) showed abnormal maximum expiratory flow at 25% of forced vital capacity (MEF25). In contrast, MR was abnormal in 31/43 (72%) and LCI in 27/43 (63%). MR was abnormal in 22/33 CF subjects with normal FEV1, versus 0/28 controls (p<0.001), and abnormal MR was found in 10/20 CF subjects with normal MEF25, versus 0/22 controls (p<0.001). Nine of the 10 CF subjects with reduced FEV1 and 12/14 with abnormal MEF25 showed abnormal MR. Inert gas washout discloses airway dysfunction in the majority of children with cystic fibrosis with normal lung function judged by spirometry. These findings suggest that multiple-breath inert gas washout is of greater value than spirometry in detecting early cystic fibrosis lung disease.

Adolescent↗
PubMed2006

Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis.

BACKGROUND: FEV1 may remain stable while high-resolution CT (HRCT) appearances deteriorate in children with cystic fibrosis (CF). However, spirometry results commonly decline in older age groups. OBJECTIVES: To compare the rate of decline in HRCT abnormalities and spirometry results over time in an adult cohort with CF. METHODS: The HRCT scans of 39 consecutive patients (19 males and 20 females; mean age, 22 years; range, 16 to 48 years) with two HRCT scans > 18 months apart were randomly and blindly scored using a modified Bhalla scoring system by two independent chest radiologists. Age, body mass index, spirometry, and sputum cultures were recorded at the time of both HRCTs. Rates of change in clinical parameters and HRCT abnormalities were calculated and compared using repeated-measures analysis of variance. RESULTS: Mean FEV1 declined at a rate of - 2.3% per year, while mean HRCT total score declined at a rate of -2.7% per year. Several individual HRCT abnormalities as well as HRCT total scores declined significantly faster than FEV1 (p < 0.001). Six patients showed stable spirometry results but worsening HRCT scores. Mucus plugging and extent of bronchiectasis deteriorated at a more rapid rate in the group with mildly impaired lung function. Air trapping, collapse/consolidation, peribronchial thickening, severity of bronchiectasis, and generations of bronchial divisions involved deteriorated at a more rapid rate in the group with moderate-to-severely impaired lung function. CONCLUSIONS: Adult CF patients have more rapid rates of decline in HRCT abnormalities than in spirometry results. Individual HRCT abnormalities decline at different rates depending on the degree of lung function impairment.

Adolescent↗
PubMed2000

[Early detection of COPD by high risk population spirometric screening].

UNLABELLED: COPD is the most frequent chronic lung disease in Poland. The disease is however under-diagnosed, especially at the early stages. The aim of the study was to assess the efficacy of spirometric screening for COPD in middle aged smokers. Informations on causes and symptoms of COPD were disseminated in mass media in 14 large cities. Subject aged over 39 and with smoking history of > 10 packyears were invited for a free spirometry in local chest clinic. However, everyone attending had the spirometry performed. Spirometry was performed according to ATS recommendations. Airway obstruction (AO) was diagnosed when FEV1/FVC < 85% of N and categorised as mild (FEV1 > 70% of N), moderate (FEV1 50-69% of N) or severe (FEV1 < 50% of N). Spirometry was accompanied by an antismoking advice. RESULTS: 12.781 subjects were screened (mean age 52 +/- 12 years, 57% males). In 8.269 subjects who complied with inclusion criteria AO was diagnosed in 29.8% (mild in 10.9%, moderate in 12% and severe in 6.9%). In smokers < 40 years of age and a history of < 10 packyears AO was found in 8.8% (mild in 6.0%, moderate in 1.8% and severe in 1.0%). CONCLUSION: Mass spirometry is an effective and easy method for early detection of COPD.

Adolescent↗
PubMed2003

Strategies for screening for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is easily detected in its preclinical phase, using office spirometry. Successful smoking cessation prevents further disease progression in most patients. Spirometry measures the ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV(1)/FVC), which is the most sensitive and specific test for detecting airflow limitation. Primary care practitioners see the majority of adult smokers, but few primary care practitioners currently have spirometers or regularly order spirometry for their smoker patients. Improvements in spirometry software have made it much easier to obtain good quality spirometry test sessions, thereby reducing the misclassification rate. Respiratory therapists and pulmonary function technologists can help primary care practitioners select good office spirometers for identifying chronic obstructive pulmonary disease and teach staff how to use spirometers correctly.

Adult↗