To determine the role of screening spirometry in a high-risk inner city population for early identification of obstructive lung disease (OLD). We hypothesized that inner city adult smokers may have a high prevalence of undiagnosed OLD and have irreversible airflow obstruction before 40 years of age as a possible result of health risk factors associated with low socio-economic status and multi-inhaled substance use.
Cross-sectional survey of an incidental sample of 300 adult cigarette smokers recruited through community gathering places in Vancouver’s inner city. Spirometry and an interviewer administered questionnaire.
Participants ranged in age from 30 to 74 years (mean 45.7 years; SD 7.8) and had a mean smoking history of 33 pack/years (range 2.5-110.0). Participants reported a high prevalence of respiratory symptoms: chronic cough (64%), chronic sputum (62%), wheezing (59%) and shortness of breath with activity (69%). A past or current history of smoking another inhaled substance was common (marijuana 45%, cocaine 36%). The prevalence of OLD was 10.7% based on the CTS criteria and 31% based on the GOLD or ATS/ERS criteria. Mild obstruction was found in 7.7% or 21.1% of all participants and severe obstruction in 1.8% or 1.1% based on the CTS and the GOLD or ERS/ATS criteria respectively. The prevalence rate of airflow obstruction (30.2%), defined by a FEV1/FVC ratio < 70%, in participants 34 to 39 years of age was not significantly different from the rate (32.9%) in participants 40 years of age or older (p=0.70). Surprisingly, only 22% of participants with objective irreversible OLD reported a physician diagnosis of chronic bronchitis,COPD or emphysema.
We found a high prevalence of undiagnosed OLD among a highly symptomatic inner city population.
Screening spirometry should be performed in inner city smokers who are 35 years of age or older to promote early detection of OLD.
E. Malone, None.