Viewpoint
The drawback of this study is that it was performed in a single urban center. The availability of trained personnel to conduct the test was not discussed as an issue, nor was the potential cost to the patient. There was no assessment of the incidence of missed COPD diagnoses due to failure to perform spirometry. Nevertheless, there is clearly skepticism among PCPs that routine office spirometry has much of an impact on patient outcomes.
COPD is currently the third most common cause of death in the United States and in most developed nations. Besides being a very common diagnosis, large demographic studies show that COPD is severely underdiagnosed.
The development of COPD is typically slow, and patients adapt to the effect it has on their life, which leads to underrecognition by the patient and the physician. The COPD patient typically presents to the caregiver when their lung function has fallen to 50% of predicted normal values and sometimes much lower. An undiagnosed COPD patient misses the symptom relief and improved quality of life that can be obtained with effective treatment. He or she also carries the risk for acute exacerbations, which can be fatal but are potentially avoidable. Other reasons why spirometry should be as routine as blood pressure measurement are given in a document from the Global Initiative for Chronic Obstructive Lung Disease(GOLD).
There is no single test for the diagnosis of COPD. It remains largely a clinical diagnosis. The correlation between COPD severity and spirometry is not nearly as strong as one would like; however, the absence of airway obstruction, as revealed by spirometry, can be reassuring and avoid inappropriate treatment. The finding of significant lung function loss can also motivate a smoker to quit.
Furthermore, the diagnosis and management of COPD occur largely in the primary care setting, where spirometry should be routine.
Abstract