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Correspondence |

Harm From Spirometry? FREE TO VIEW

Thomas L. Petty, MD, Master FCCP
Author and Funding Information

Denver, CO

Correspondence to: Thomas L. Petty, MD, Master FCCP, Snowdrift Pulmonary Conference, 899 Logan St, Suite 103, Denver, CO 80203-3154; e-mail: tlpdoc@aol.com



Chest. 2006;130(5):1629-1630. doi:10.1378/chest.130.5.1629
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Published online

To the Editor:

The recent editorial by Enright (April 2006),1and his rhetorical title, prompts this reply. Dr. Enright cites a carefully done Italian study2 that fails to prove that spirometry done by primary care physicians improves the diagnosis of asthma or COPD. In fact, this study2was inconclusive but did serve to demonstrate some of the barriers to the widespread use of office spirometry, which I have commented about elsewhere,3 along with the benefits. Dr. Enright fears that spirometry will cause big pharmaceutical companies to promote inhalers more vigorously than without spirometry. Is there evidence to support this contention?

About 30 years ago, I wrote an editorial in CHEST4advising the early diagnosis of COPD. This was after the successful follow-up of a prevalence study5 for COPD that showed a high mortality over 7 years in patients with airflow obstruction.

In the 3 decades that have followed, the monumental Lung Health Study67 has shown that the adverse course and prognosis of early stage COPD can be greatly improved through smoking cessation up to 14.5 years of follow-up. Thus, it is clear that knowledge of an abnormality in spirometry results, followed by smoking cessation, does identify a population at high risk in whom intervention can be successful. Survival was convincingly improved in quitters!

But does performing spirometry improve smoking quit rates other than in an National, Heart, Lung, and Blood Institute trial? Two old studies5,8 strongly suggest that community screening does just this. More smokers with the knowledge of airflow obstruction quit than if they had abnormal airflow, but both groups moved away from smoking!

Other studies910 have also shown that spirometry can help quit rates when COPD is first diagnosed as a result of spirometry. In these studies,910 the spirometry was done in special laboratories and not by primary care physicians. Office spirometry has been shown to increase the diagnosis of COPD in general practice.11However, another recent study12 showed little benefit from an instruction period and the providing of free spirometers and supplies, plus advice on reimbursement in primary care physician’s offices. Thus, controversy continues.

My conclusion remains that spirometry is effective in smoking cessation, but we need to find better ways to promote this simple test in doctors’ offices. This is the goal of the National Lung Health Education Program, which was launched a decade ago.1314 Failure to achieve our goals thus far should only increase our efforts to succeed. We have the need, the simple tools, and the goal of reducing the impact of COPD. We just need to do it!

The author has no conflicts of interest to disclose.

Enright, P (2006) Does screening for COPD by primary care physicians have the potential to cause more harm than good?Chest129,833-835. [CrossRef]
 
Lusuardi, M, DeBenedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice.Chest2006;129,844-852. [CrossRef]
 
Petty, TL Benefits of and barriers to the widespread use of spirometry.Curr Opin Pulm Med2005;11,115-120
 
Petty, TL Test your lungs?Chest1976;70,450-451. [CrossRef]
 
Petty, TL, Pierson, DJ, Dick, NP, et al Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction.Am Rev Respir Dis1976;114,881-890
 
Anthonisen, NR, Connett, JE, Kiley, JP, et al Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study.JAMA1994;272,1497-1505. [CrossRef]
 
Anthonisen, NR, Skeans, MA, Wise, RA, et al The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.Ann Intern Med2005;142,233-239. [CrossRef]
 
Hepper, NG, Drage, CW, Davies, SF, et al Chronic obstructive pulmonary disease: a community-oriented program including professional education and screening by a voluntary health agency.Am Rev Respir Dis1980;121,97-104
 
Zielinski, J, Bevmarck, M Early detection in a high-risk population using spirometry screening.Chest2001;119,731-736. [CrossRef]
 
Gorecka, D, Bednarek, M, Nowinski, A, et al Diagnosis of airflow limitation combined with smoking cessation advice increases stop smoking rates.Chest2004;123,1916-1923
 
Buffels, J, Degryse, J, Heyman, J, et al Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study.Chest2004;125,1394-1399. [CrossRef]
 
Kaminsky, DA, Marcy, TW, Bachand, M, et al Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians.Respir Care2005;50,1639-1648
 
Petty, TL, Weinmann, GG Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease.JAMA1997;277,246-253. [CrossRef]
 
Petty, TL Strategies in preserving lung health and preventing COPD and associated diseases: the National Lung Health Education Program (NLHEP).Chest1998;113,123S-163S. [CrossRef]
 

Figures

Tables

References

Enright, P (2006) Does screening for COPD by primary care physicians have the potential to cause more harm than good?Chest129,833-835. [CrossRef]
 
Lusuardi, M, DeBenedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice.Chest2006;129,844-852. [CrossRef]
 
Petty, TL Benefits of and barriers to the widespread use of spirometry.Curr Opin Pulm Med2005;11,115-120
 
Petty, TL Test your lungs?Chest1976;70,450-451. [CrossRef]
 
Petty, TL, Pierson, DJ, Dick, NP, et al Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction.Am Rev Respir Dis1976;114,881-890
 
Anthonisen, NR, Connett, JE, Kiley, JP, et al Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study.JAMA1994;272,1497-1505. [CrossRef]
 
Anthonisen, NR, Skeans, MA, Wise, RA, et al The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.Ann Intern Med2005;142,233-239. [CrossRef]
 
Hepper, NG, Drage, CW, Davies, SF, et al Chronic obstructive pulmonary disease: a community-oriented program including professional education and screening by a voluntary health agency.Am Rev Respir Dis1980;121,97-104
 
Zielinski, J, Bevmarck, M Early detection in a high-risk population using spirometry screening.Chest2001;119,731-736. [CrossRef]
 
Gorecka, D, Bednarek, M, Nowinski, A, et al Diagnosis of airflow limitation combined with smoking cessation advice increases stop smoking rates.Chest2004;123,1916-1923
 
Buffels, J, Degryse, J, Heyman, J, et al Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study.Chest2004;125,1394-1399. [CrossRef]
 
Kaminsky, DA, Marcy, TW, Bachand, M, et al Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians.Respir Care2005;50,1639-1648
 
Petty, TL, Weinmann, GG Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease.JAMA1997;277,246-253. [CrossRef]
 
Petty, TL Strategies in preserving lung health and preventing COPD and associated diseases: the National Lung Health Education Program (NLHEP).Chest1998;113,123S-163S. [CrossRef]
 
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