Spirometry to detect and manage chronic obstructive pulmonary disease and asthma in the primary care setting

Most people with chronic obstructive pulmonary disease (COPD) are unaware of the smoldering airway inflammation present in their lungs, which places them at increased risk for premature morbidity and mortality [1–3]. However, COPD is easily detected in its preclinical phase using office spirometry; and successful smoking cessation prevents further disease progression [4]. In the near future, other interventions may also be proven to reduce the rapid decline in lung function experienced by patients with chronic airflow limitation. When patients complain of intermittent cough, wheezing, chest tightness, and shortness of breath, spirometry carried out when the symptoms remain current can often detect the reversible airflow limitation characteristic of asthma. Spirometry also helps to categorise the severity of asthma and confirms response to therapy [5]. Office spirometry is defined as spirometry performed in the primary care (general practitioner) setting. Office spirometry measures the forced expiratory volume in one second (FEV1)/vital capacity (VC) ratio (or surrogates like FEV1/forced vital capacity (FVC) or FEV1/forced expiratory volume in six seconds (FEV6)). This ratio is the most sensitive and specific test for detecting airflow limitation. Spirometry also measures the per cent predicted FEV1, which is the most widely accepted index of the severity of airway obstruction [6, 7]. General practitioners see the majority of adult smokers and patients with asthma, but fewer than half use an office spirometer regularly [8, 9]. Barriers include the perceptions that spirometers are expensive and difficult to use and maintain, that the test disturbs patients and takes too much time to complete, that the reports are too difficult to interpret, and that spirometry testing does not affect clinical outcomes.