Chest
Volume 117, Issue 4, April 2000, Pages 1146-1161
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Special Report
Office Spirometry for Lung Health Assessment in Adults: A Consensus Statement From the National Lung Health Education Program

https://doi.org/10.1378/chest.117.4.1146Get rights and content

COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients ≥ 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry—office spirometry—for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Section snippets

Recommendation

Primary-care providers (PCPs) should perform an office spirometry test for patients ≥ 45 years old who report smoking cigarettes (current smokers and those who quit during the previous year) in order to detect COPD.

Rationale: Several well-recognized criteria have been established for the use of medical tests that have been proposed for the early detection of disease,30, 3132, 3334 and spirometry for the detection of COPD in adult cigarette smokers fulfills all of these criteria:

  • 1.

    The disease, if

Recommendation

A new category of spirometers, office spirometers, should be available for use in the primary-care setting. Each new model must successfully pass a validation study (see Appendix 1).

Rationale: Traditionally, spirometry has been used as a diagnostic test, with the usefulness and accuracy of spirometry measurements depending on both the equipment and proper test performance. Although simple to learn, spirometry is an effort-dependent test that requires a cooperative patient and a trained person

Background

The NLHEP recommends the widespread use of spirometry by PCPs for detecting COPD in adult smokers and describes a new type of spirometer for this purpose: the office spirometer. The value of spirometry for aiding the diagnosis of COPD and asthma, when performed by trained technicians using diagnostic spirometers that meet current ATS recommendations, is widely accepted. The accuracy and precision of diagnostic-quality spirometry performed in the hospital PF laboratory, pulmonary research

ACKNOWLEDGMENT

The authors thank Millicent Higgins from the University of Michigan, David Mannino from the Center for Disease Control, and Gregory Wagner and Kathleen Fedan from the National Institute for Occupational Safety, who collaborated to provide new analyses for this document from the NHANES III database.

References (118)

  • MR Becklake

    Occupational and environmental lung disease: chronic airflow limitation: its relationship to work in dusty occupations

    Chest

    (1985)
  • RG Badgett et al.

    Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?

    Am J Med

    (1993)
  • RG Badgett et al.

    The clinical evaluation for diagnosing obstructive airways disease in high risk patients

    Chest

    (1994)
  • KM Freund et al.

    The health risks of smoking: the Framingham study; 34 years of follow-up

    Ann Epidemiol

    (1993)
  • KM Bang et al.

    The effect of pulmonary function impairment on all-cause mortality in a national cohort

    Chest

    (1993)
  • VL Burt et al.

    Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991

    Hypertension

    (1995)
  • CI Johnson et al.

    Declining serum cholesterol levels among US adults. The National Health and Nutrition Examination Surveys

    JAMA

    (1993)
  • HC Sox

    Preventive health services in adults

    N Engl J Med

    (1994)
  • Preventive Services Task Force

    Guide to clinical preventive services

    (1989)
  • Canadian Task Force on Periodic Health Examination

    The periodic health examination, 1987 update

    Can Med Assoc J

    (1988)
  • Singh GK, Matthews TJ, Clarke SC, et al. Annual summary of births, marriages, divorces, and deaths: United States,...
  • J O'Hagan

    Prevention of chronic obstructive pulmonarydisease: a challenge for the health professions

    N Z Med J

    (1996)
  • Canadian Thoracic Society

    Guidelines for the assessment and management of chronic obstructive pulmonary disease

    Can Med Assoc J

    (1992)
  • American Thoracic Society

    Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1995)
  • NM Siafakas et al.

    Optimal assessment and management of chronic obstructive pulmonary disease (COPD): The European Respiratory Society Task Force

    Eur Respir J

    (1995)
  • American Thoracic Society

    Standardization of spirometry: 1994 update

    Am J Respir Crit Care Med

    (1995)
  • JG Hansen et al.

    Obstructive ventilatory impairment: an investigation in general practice

    Scand J Prim Health Care

    (1991)
  • PRS Tirimanna et al.

    Prevalence of asthma and COPD in general practice: has it changed since 1977?

    Br J Gen Pract

    (1996)
  • JJ Otter et al.

    How to avoid underdiagnosed asthma and COPD?

    J Asthma

    (1998)
  • American Thoracic Society

    Screening for adult respiratory disease

    Am Rev Respir Dis

    (1983)
  • RW Loss et al.

    Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing

    Am J Med Sci

    (1979)
  • AS Buist et al.

    A comparison of conventional spirometric tests and the test of closing volume in an emphysema screening center

    Am Rev Respir Dis

    (1973)
  • TH Beaty et al.

    Risk factors associated with longitudinal change in pulmonary function

    Am Rev Respir Dis

    (1984)
  • J Olfsson et al.

    The single breath N2-test predicts the rate of decline in FEV1: the study of men born in 1913 and 1923

    Eur J Respir Dis

    (1986)
  • SE Gentry et al.

    Pulmonary function testing in a general medical practice

    J Community Health

    (1983)
  • JA Hughes et al.

    The influence of cigarette smoking and its withdrawal on the annual change of lung function in pulmonary emphysema

    Q J Med

    (1982)
  • AE Camilli et al.

    Longitudinal changes in FEV1 in adults: effects of smoking and smoking cessation

    Am Rev Respir Dis

    (1987)
  • JL Hankinson et al.

    Spirometric reference values from a sample of the general U.S. population

    Am J Respir Crit Care Med

    (1999)
  • NR Anthonisen et al.

    Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study

    JAMA

    (1994)
  • TL Petty et al.

    Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease: NHLBI workshop summary

    JAMA

    (1997)
  • AC Cochrane et al.

    Validation of screening programmes

    Br Med Bull

    (1971)
  • DL Sackett

    Screening for early detection of disease: to what purpose?

    Bull N Y Acad Med

    (1975)
  • KG Marshall

    Prevention: how much harm?; how much benefit? 1. Influence of reporting methods on perception of benefits

    CMAJ

    (1996)
  • KG Marshall

    Prevention: how much harm?; how much benefit? 3. Physical, psychological, and social harm

    CMAJ

    (1996)
  • National Heart, Lung, and Blood Institute

    Morbidity and mortality: chartbook on cardiovascular, lung, and blood diseases

    (1998)
  • National Center for Health Statistics

    Health in the United States, 1993

    (1995)
  • MW Higgins et al.

    Incidence, prevalence, and mortality: intra- and inter-county differences

  • Benson V, Marano MA. Current estimates from the 1993 National Health Interview Survey. Bethesda, MD: National Center...
  • JC Collins

    Prevalence of selected chronic conditions: United States, 1990–1992

    (1997)
  • GT Ferguson et al.

    Management of chronic obstructive pulmonary disease

    N Engl J Med

    (1993)
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    Although representatives from NIOSH participated in the NLHEP conferences and reviewed drafts of this document, official approval from NIOSH was not obtained.

    A complete list of NHLBI/ACCP Consensus Conference participants, NHLBI-sponsored NLHEP Conference participants, members of the Spirometry Subcommittee of the NLHEP, and members of the Executive Committee of the NLHEP is located in Appendix 2

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