The use of microspirometry in detecting lowered FEV1 values in current or former cigarette smokers

Abstract

Aims: COPD is an underdiagnosed disease. This study was undertaken to assess the value of microspirometry in detecting reduced FEV 1 values in cigarette smokers i.e. subjects at high risk for COPD.Methods: A total of 611 smokers or ex-smokers with a smoking history >20 years and no previously-diagnosed lung disease were recruited (389 male, age 27-83 years, mean age 56 years, mean smoking history 35 pack years, 19% ex-smokers).Results: An FEV 1 < 80% predicted on microspirometry was found in 44.6% of cases. The mean FEV 1 was 2.8 litres (80.6% predicted, range 26-121%). This correlated well with values obtained from full spirometry (R=0.965, p<0.0001). Detailed questionnaire responses revealed that almost half of the subjects (48.2%) reported chronic cough and sputum production and 39.8% reported breathlessness during exercise.Conclusions: Microspirometry finds a considerable number of smokers or ex-smokers with reduced FEV 1 values. Microspirometry is quick to perform. All smokers with reduced microspirometry FEV 1 values would benefit from smoking cessation, and all patients with reduced FEV 1 values need to be considered for full spirometry to confirm if they actually have COPD.

The 10-year COPD Programme in Finland: effects on quality of diagnosis, smoking, prevalence, hospital admissions and mortality

“…With this proviso, screening was recommended in certain situations such as in the health care units of occupational health centres where each employee has to be examined according to legislation. Another reason to include the screening option is the fact that detecting airway obstruction can be straightforward, quick, 27 and not dangerous at all; on these occasions all smokers can be encouraged to quit and this may have real significance. 28,29 It is also important to detect symptomatic COPD, since symptoms are likely to progress.…”

The use and abuse of office spirometry

“…As described by Rytila et al 2 and others, 47 lower false positive rates will be obtained -with no loss of sensitivity for smokers who may benefit from a COPD inhaler -if inexpensive pocket spirometers are used to exclude substantial airway obstruction in primary care settings. Furthermore, inexpensive mechanical peak expiratory flow (PEF) meters can be used; a ground-breaking report from the PLATINO and BOLD studies demonstrates that a normal PEF measurement can confidently exclude GOLD Stage III or more severe COPD in smoking adults.…”

“…1,2 Similar efforts in other countries have not been successful, despite local pulmonary specialists providing free training, and drug companies providing free spirometers and supplies. [3][4][5][6][7] The three most common evidence-based indications for office spirometry are: to detect COPD; to determine the severity of asthma; and to measure the response to asthma medications.…”

Diagnosis of asthma in adults

“…27,30 Spirometry is commonly performed in pulmonary function laboratories, but can be performed efficiently in primary care offices as well. 31 Portable hand-held spirometers allow screening for obstruction 32 and may be more easily used for this purpose than laboratory-based spirometry equipment. Out-of-office spirometry may be more timeconsuming and hence less desirable for patients -and, because feedback is delayed, less desirable for physicians -than spirometry done in primary care practice [33][34][35][36] and specialist practice.…”