PURPOSE: Recent guidelines, such as the Global Initiative for Chronic Obstructive Lung Disease, have strongly recommended the use of spirometry to detect early stage chronic obstructive lung disease (COPD). The purpose of this study is to determine whether screening spirometry is routinely used by physicians in patients at risk for COPD in an internal medicine clinic at a large military academic hospital.
METHODS: Five hundred volunteers over the age of 40 presenting for routine care at the Internal Medicine Clinic at Naval Medical Center San Diego completed a written survey regarding smoking habits, symptoms, and the ordering of spirometry by their primary care physician.
RESULTS: The mean age of the participants was 70 years (range 40-93) with an equal male/female ratio (49%/51%). 46% of respondents were former smokers, 5.8% current smokers, and 48% reported no smoking history. Symptoms of cough, sputum/phlegm production, or shortness of breath at rest or with exercise on a “daily” or “near daily” basis was reported by 45.8% of previous smokers, while 55.2% of current smokers and 24.6% of never smokers reported one or more of these symptoms. This compares with estimates from the National Health and Nutrition Examination Survey III data of 34.8%, 52.5%, and 27.4% respectively. Only 46.6% of former smokers with symptoms had been referred for spirometry, compared with 69.2% of current smokers and 43.1% of never smokers.
CONCLUSION: Smoking rates among United States military personnel have historically exceeded that of the general population. For this reason, the percentage of former smokers in military and veterans clinics is very high. This survey found that the majority of former smokers with symptoms suggestive of COPD had not been screened with spirometry. The reasons for not screening are probably multifactorial but likely include a lack of awareness of current guidelines by primary care providers.
CLINICAL IMPLICATIONS: Educational programs to train primary care providers, particularly those involved in the care of military retirees, about current published guidelines may increase the detection of COPD in at risk patients.
DISCLOSURE: Frank Grassi, None.