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Denver, CO
Correspondence to: Thomas L. Petty, MD, Master FCCP, Snowdrift Pulmonary Conference, 899 Logan St, Suite 103, Denver, CO 80203-3154; e-mail: tlpdoc{at}aol.com
To the Editor:
The recent editorial by Enright (April 2006),1 and his rhetorical title, prompts this reply. Dr. Enright cites a carefully done Italian study2 that fails to prove that spirometry done by primary care physicians improves the diagnosis of asthma or COPD. In fact, this study2 was inconclusive but did serve to demonstrate some of the barriers to the widespread use of office spirometry, which I have commented about elsewhere,3 along with the benefits. Dr. Enright fears that spirometry will cause big pharmaceutical companies to promote inhalers more vigorously than without spirometry. Is there evidence to support this contention?
About 30 years ago, I wrote an editorial in CHEST4 advising the early diagnosis of COPD. This was after the successful follow-up of a prevalence study5 for COPD that showed a high mortality over 7 years in patients with airflow obstruction.
In the 3 decades that have followed, the monumental Lung Health Study67 has shown that the adverse course and prognosis of early stage COPD can be greatly improved through smoking cessation up to 14.5 years of follow-up. Thus, it is clear that knowledge of an abnormality in spirometry results, followed by smoking cessation, does identify a population at high risk in whom intervention can be successful. Survival was convincingly improved in quitters!
But does performing spirometry improve smoking quit rates other than in an National, Heart, Lung, and Blood Institute trial? Two old studies58 strongly suggest that community screening does just this. More smokers with the knowledge of airflow obstruction quit than if they had abnormal airflow, but both groups moved away from smoking!
Other studies910 have also shown that spirometry can help quit rates when COPD is first diagnosed as a result of spirometry. In these studies,910 the spirometry was done in special laboratories and not by primary care physicians. Office spirometry has been shown to increase the diagnosis of COPD in general practice.11 However, another recent study12 showed little benefit from an instruction period and the providing of free spirometers and supplies, plus advice on reimbursement in primary care physician’s offices. Thus, controversy continues.
My conclusion remains that spirometry is effective in smoking cessation, but we need to find better ways to promote this simple test in doctors’ offices. This is the goal of the National Lung Health Education Program, which was launched a decade ago.1314 Failure to achieve our goals thus far should only increase our efforts to succeed. We have the need, the simple tools, and the goal of reducing the impact of COPD. We just need to do it!
Footnotes
The author has no conflicts of interest to disclose.
References
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