New Data Suggests Spirometry For Older Smokers

The US Preventive Services Task Force recommends against spirometry in patients who smoke who have no symptoms. However, new research suggests that this approach to COPD screening may be less than ideal. Researchers from Wake Forest University School of Medicine, Winston-Salem, NC, reviewed medical evaluations in 2,917 smokers, of which 1,269 had COPD, 792 had normal spirometry results, and 856 had restrictive spirometry findings. Overall, symptoms were present in 92 percent of patients with COPD. Smokers with COPD were older, smoked more, and experienced more symptoms than smokers with normal or restrictive spirometry results. Of the 744 long-term smokers with airway obstruction who were not diagnosed with COPD, 80 percent were GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification stage 2 or greater and 87 percent had one or no symptoms. Furthermore, although all symptoms were significantly associated with COPD, smoking history (≥20 pack-years) was the strongest predictor for COPD. Researchers conclude that COPD is underdiagnosed and that a more effective approach to diagnosis would be screening smokers aged ≥40 years and those with a history of ≥20 pack-years. This article is published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.