Vol. 19 • Issue 12 • Page 16
Allergy And Asthma
Add 74,316 to the number of people breathing easier after the first World Spirometry Day.
Public spirometry screenings were held across the continents Oct. 14 in conjunction with the Forum of International Respiratory Societies’ Year of the Lung. But the work promoting spirometry is not finished. Only one in five people who should get tested actually do.1 Misconceptions about the device – and the diseases it is used to diagnose – pervade health care interactions.
More than half of patients with abnormal lung function are unaware of it. Older patients blame their increased breathlessness on advancing age, decreased physical activity, and past smoking.
“We often see the consequences of late diagnosis,” said Darcy D. Marciniuk, MD, FRCP(C), FCCP, co-chair of World Spirometry Day-North America. Chronic obstructive pulmonary disease is poised to become the third leading cause of death worldwide by 2020. “You don’t want to create public outcry and hysteria but (these statistics) are pretty significant.”
On the other end of the age spectrum are the 7.1 million U.S. children who currently have asthma. Asthma misdiagnosis is common among this group, and spirometry can be a helpful tool in distinguishing it from conditions such as vocal cord dysfunction.2
Challenging perceptions
Despite the relatively low cost of the test, many physicians today do not implement spirometry in their practice. “There is a perception that it is easy to make a diagnosis without objective information,” said Marciniuk, who is head of the division of respirology, critical care, and sleep medicine at University of Saskatchewan, Royal University Hospital in Saskatoon, Canada.As with asthma, wrong diagnosis occurs often; some patients diagnosed with COPD are found to have normal lung function, and as many as 50 percent of patients with COPD are undiagnosed.2
“It is changing,” Marciniuk said. “There are very good guidelines now to establish diagnosis at an early stage.” The Global Initiative for Chronic Obstructive Lung Disease in June 2010 endorsed performing spirometry in individuals 40 years old or older with any risk factors for COPD.
More controversial is the screening of asymptomatic smokers. More than a quarter of smokers or ex-smokers, age 35 or older, tested by spirometry had airway obstruction. However, some experts contend that testing of this group is not cost-effective.2
Spirometry also can confirm when patients with asthma have flare-ups or whether their medication and action plan have helped establish good asthma control; however, primary care physicians and pediatricians are not using this method enough.
Fewer than half use spirometry in asthma management – and only 35 percent of pediatricians do. Most prefer using peak flow meters to assess lung function. Confidence in using peak flow devices likely tips the scales in their favor. Nearly 80 percent of physicians are comfortable interpreting these results compared with 35 percent who can interpret spirometric results.3
Testing practice
Correct performance of spirometry maneuvers also challenges the test’s usage. “Some of what we hear from patients is that it is a difficult test to take,” Marciniuk said.
Many primary care physicians, nurses, and health care providers outside the pulmonary function lab have had little formal training in spirometry.4 The American Thoracic Society, a FIRS partner, has developed an online course to teach the basics of spirometry, how to interpret test results, and how to effectively communicate results to primary care physicians and patients.
It uses patient vignettes, surveys, and a chart review to illustrate best practices. The training grades physicians’ existing performance based on a careful set of key measures. Pulmonary function experts also can sign up to mentor family physicians after the physicians have completed the module.
Continuing to educate colleagues and the public about spirometry is vital to decreasing lung disease, Marciniuk said. “This is something that you have to sustain throughout the years.”
Look under the “Magazine” tab at www.advanceweb.com/respiratory for a reference list.
Kristen Ziegler can be reached at [email protected].
