Use of spirometry for case finding, diagnosis, and management of chronic obstructive pulmonary disease (COPD)
Wilt TJ, Niewoehner D, Kim CB, Kane R L, Linabery A, Tacklind J, MacDonald R, Rutks I
Record ID 32005001187
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. COPD is diagnosed in symptomatic individuals through spirometric testing demonstrating irreversible airflow obstruction. Spirometry in primary care settings for casefinding, diagnosis, and management in all adults with persistent respiratory symptoms or having a history of exposure to pulmonary risk factors is controversial.
The aims of this study were to conduct a systematic review to determine:
1) the prevalence of COPD and airflow obstruction; 2) if spirometry improves smoking cessation; 3) if effectiveness of COPD therapies varies based on baseline or change in spirometric severity; 4) whether spirometry provides independent prognostic value related to pulmonary outcomes.
Spirometry, in addition to clinical examination, improves COPD diagnostic accuracy compared to clinical examination alone and it is a useful diagnostic tool in individuals with symptoms suggestive of possible COPD. The primary benefit of spirometry is to identify individuals who might benefit from pharmacologic treatment in order to improve exacerbations. These include adults with symptomatic, severe to very severe airflow obstruction. Spirometry for case finding among all adults with persistent respiratory symptoms or those with a history of exposure to pulmonary risk factors as well as for monitoring individuals or adjusting treatment is unlikely to be beneficial unless future studies establish that spirometry improves smoking cessation rates, treatments other than smoking cessation benefit individuals with airflow obstruction who do not report respiratory symptoms, or that relative effectiveness between therapies varies according to an individuals baseline or followup spirometry. Widespread spirometric testing is likely to label a large number of individuals (many who do not report respiratory symptoms) with disease and result in considerable testing and treatment costs and health-care resource utilization.
English language abstract:
An English language summary is available
- Smoking Cessation
- Pulmonary Disease, Chronic Obstructive
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Agency for Healthcare Research and Quality (AHRQ)