For Release: April 11, 2000
Contact: Kymberly Lynch, ACCP
847/498-8341
[email protected]
NEW FORM OF OFFICE SPIROMETRY URGED TO DETECT TREATABLE LUNG DISEASE IN SMOKERS
A just-released consensus statement calls for more widespread use of a new form of spirometry -- office spirometry -- as a critical step in the detection of more chronic obstructive pulmonary disease (COPD) in its most treatable stage, particularly in smokers over 45 years old.
The statement was released by the National Lung Health Education Program (NLHEP) in the April issue of the peer-reviewed journal, CHEST. The NLHEP is sponsored by several medical professional groups including the American College of Chest Physicians (ACCP) which publishes CHEST.
COPD, representing mostly emphysema and chronic bronchitis, is the most serious of lung diseases and is the fourth leading cause of death in the United States. Of the top ten causes of death, only COPD mortality continues to rise, increasing by 22 percent in the last decade. Its prevalence is now rising faster in women than men. Every year it causes 100,000 deaths and 550,000 hospitalizations, as well as $13 billion per year in medical costs. COPD generally occurs in current and former smokers. To a much lesser degree, it can be found in individuals who are exposed to occupational dust, environmental tobacco smoke, air pollution, or who have a relatively rare genetic disease, i.e. alpha1-antitrypsin deficiency.
The consensus statement notes that the widely accepted definition of COPD progression is an abnormal rate of decline in lung function. Prevalence rates of low function increase with age and are highest in crrent smokers, intermediate in former smokers, and lowest in never smokers.
Traditional spirometry records the total volume of air breathed out, known as the forced vital capacity (FVC). It also records the volume of air breathed out in one second, known as the forced expiratory volume in one second (FEV1). In COPD, the FEV1/FVC ratio is reduced because the airways are narrowed.
Authors of the consensus statement noted that data coming from the multi-center Lung Health Study (LHS) showed that an intense smoking cessation effort can lead to a quit rate of 35% in asymptomatic smokers, and that the rate of decline of FEV1 following cessation was very similar to that seen in healthy nonsmokers. The LHS was the first study to demonstrate prospectively that early intervention in smokers identified to be at risk of COPD could modify the natural history of the disease. However, the authors point out that primary care physicians now rarely use spirometry to detect COPD in smokers.
In an effort to increase the use of spirometry among primary care physicians, the consensus statement calls for the widespread use of the new office spirometers which differ in specifications somewhat from the more traditional spirometers used for diagnosis. The new office spirometers, they say, are less expensive, smaller in size, require less effort to perform the test, have improved ease of calibration, and have an improved quality-assurance program. Office spirometry, the authors said, takes only a few minutes of the patient's and technician's time and includes a few athletic-type breathing maneuvers of six seconds' duration. The traditional diagnostic spirometers currently cost about $2,000 and about $10 of time per test is spent in testing (including training time) and disposable supplies. Office spirometers will cost less than $800 and require even less testing time than diagnostic spirometers.
The consensus statement called on primary physicians to use office spirometry on all patients 45 or older who smoke. Discussion of the spirometry results with smokers, they add, should be accompanied by strong advice to quit smoking, and referral to local smoking cessation resources. Office spirometry was also recommended for patients with respiratory symptoms such as chronic cough, sputum production, wheezing, or dyspnea on exertion in order to detect COPD or asthma.
While advocating that office spirometry be used for early lung health assessment, the consensus statement said it should not be used for diagnostic testing, surveillance for occupational lung disease, disability evaluations, or research purposes.
The consensus statement was based on conferences sponsored by the ACCP and the National Heart, Lung, and Blood Institute of the National Institutes of Health and reflect the findings of the participants of those conferences.
CHEST is published by the American College of Chest Physicians which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
_________________________________________________________________
Reporters may wish to contact Kimberly Lynch of the ACCP at (847) 498-8341 for a full copy of this consensus statement. She can also be reached by fax at (847) 498-5460 or by email at [email protected].
One of the lead authors of the consensus statement, Paul L. Enright, M.D., of the University of Arizona, can be reached by email at [email protected].
RSS