Spirometry in old age.

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent in older people [1–4]. This well established fact has not, however, overcome the problem of underdiagnosis or misdiagnosis of both conditions in old age, with the inevitable effect on morbidity , and possibly mortality [1, 5]. Properly performed spirometric measurements of Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC), and the changes in those indices in response to bron-chodilator or bronchoconstrictor drugs, are the cornerstones of the diagnosis. Moreover, the often subtle or atypical presentation of asthma and COPD in elderly patients places an even greater emphasis on the need for supporting spirometric evidence of those conditions in such patients [6]. There are several reasons for the under-use of basic spirometry in older patients, though one of the most ill conceived is the perception that older people are unable adequately to perform the tests. In this edition of Age and Ageing Pezzoli et al. present a paper which addresses directly the issue of data quality from spiro-metry in older people with respiratory symptoms [7]. They showed in a large sample that the majority (81.8%) were able to meet the ATS'94 criteria [8] for adequate diagnostic quality. A poor performance was associated with lower scores on cognitive and functional testing, or a lower level of educational attainment. Within the sample, age was not an independent determining factor for poor performance; an important finding particularly since the mean age in this study was only 75 but with a wide range of 65–94 years. These findings concord broadly with those of Bellia et al. [9] (although age was independently associated with a poor FEV1 technique in that study), and other studies of the relationship between cognition and lung function testing [10]. Of course, it must be born in mind that the prevalence of cognitive impairment rises with age, so in very elderly groups the proportion of patients unable to do spirometry would be expected to be higher than the mean found in this study, despite the lack of an independent effect of age. Not surprisingly, these findings are consistent with the observed relationship between cognitive function and the ability to use inhaler devices in elderly patients [11, 12]. The study also reinforces the need for strict quality criteria and good supervision of the spirometric tests especially in a patient group where performance is expected to be poor in a …