Spirometry in the primary care setting: influence on clinical diagnosis and management of airflow obstruction

STUDY OBJECTIVE: To determine if screening spirometry in the primary care setting influences the physician's diagnosis and management of obstructive lung disease. DESIGN: Diagnosis and management assessed before and after the intervention of screening spirometry. PARTICIPANTS: A total of 1,034 patients who had ever smoked and were at least 35 years of age presenting to primary care practices for any reason. SETTING: Rural primary care practices. MEASUREMENTS AND RESULTS: Physicians were asked prior to and following presentation of spirometry test results if they thought airflow obstruction was present and if they planned to change management based on the results. A new diagnosis of unsuspected airflow obstruction was made by the physician in 93 patients (9%), and a prior diagnosis of airflow obstruction was removed after spirometry in 115 patients (11%). After viewing the spirometry results, physicians reported that they would change patient management in 154 patients (15%). Most planned management changes occurred when airflow obstruction was newly diagnosed (57 of 93 patients, 61%) and when the diagnosis of airflow obstruction remained unchanged (80 of 195 patients, 41%). A 6-month chart review documented the addition of respiratory medications in 8% of patients. CONCLUSION: Screening spirometry influences physicians' diagnosis of airflow obstruction and management plans especially in patients with moderate-to-severe obstruction.     

The prevalence of airflow obstruction in rural primary care

Spirometry has been reported to be under-utilized, and airflow obstruction may be under-diagnosed, in primary care practice. STUDY OBJECTIVES: The objective of this study was to determine the prevalence and severity of airflow obstruction in rural primary care settings and the degree to which it can be predicted by clinical characteristics. Spirometry was performed in patients 35 years and older who had smoked, presenting for any reason to one of eight rural primary care practices. Obstruction was defined as an FEV(1)/FVC<0.70. A total of 1046 subjects were recruited of whom 1034 had acceptable and reproducible spirometry. Airflow obstruction was detected in 17.4% (180 patients). Of those with obstruction, 77.2% (se 3.1%) had at least one respiratory symptom versus 62.4% (se 1.6%) without obstruction (P=0.0002). Only 44.9% (se 3.7%) of those with airflow obstruction had been previously diagnosed with obstructive lung disease. Of those with an FEV(1)<50% of predicted, 85% (se 5.6%) were breathless on exertion; however, only 63% (se 7.6%) were being treated with respiratory medications. We conclude that airflow obstruction is common in rural primary care practice and cannot be accurately predicted by symptoms. It is undiagnosed half of the time, and often not treated even when symptomatic.     

The health impact of undiagnosed airflow obstruction in a national sample of United States adults

To determine the health and functional impact of undiagnosed airflow obstruction for subjects in the general population, we used data obtained as part of the Third National Health and Nutrition Examination Survey (NHANES III). Categories of diagnosed and undiagnosed airflow obstruction were defined using questionnaire responses and spirometric results. Health and functional impact of airflow obstruction was assessed from responses to questions about general health status, walking 1/4 mile, lifting or carrying something as heavy as 10 lb, or needing help with personal care. Undiagnosed airflow obstruction (12.0%) was more common than doctor-diagnosed chronic obstructive pulmonary disease (COPD) (3.1%) or asthma (2.7%). Although undiagnosed airflow obstruction was usually very mild, approximately 5% of the entire sample had an FEV(1) less than 75% predicted. After adjusting for smoking, obesity, and comorbid conditions, the risk of impaired health and functional status with undiagnosed airflow obstruction was independently associated with severity of FEV(1) impairment. For males and females, ever smoking was strongly associated with all types of airflow obstruction, diagnosed or not. However, among females with airflow obstruction, 12.2% to 35.2% never smoked. Undiagnosed airflow obstruction is common in the general population of the United States and is associated with impaired health and functional status. Keywords: airflow obstruction; spirometry; health impact; screening     

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America.

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction. A population-based, multicentre study was carried out and included 5,571 subjects aged > or =40 yrs living in one of five Latin American metropolitan areas: Sao Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician. The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator <0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively. In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.     

Persistent cough and sputum: prevalence and clinical characteristics in south east England.

In order to measure the prevalence of chronic respiratory symptoms in the population and to identify subjects for a case-referent study of aetiologic factors, 10,000 persons registered with general practices in south east England were surveyed. Responses to an initial postal questionnaire were validated by telephone interview; clinical interviews and simple spirometry were subsequently carried out on a sample of persons aged 5-54 years, reporting persistent sputum production. Results indicated that the postal questionnaire was an effective and sensitive method of surveying respiratory symptoms in the population. Comparison with earlier surveys suggests that the prevalence of chronic cough and sputum in Great Britain has fallen in males but not in females. Of those adults reporting persistent sputum production, high proportions reported associated symptoms of wheezing (54%), breathlessness (45%) or upper respiratory tract symptoms (54%). Thirty percent recalled a serious respiratory infection in childhood and 52% were current cigarette smokers although 34% reported that they had never been regular smokers. Overall there was little evidence of serious airflow obstruction in this group.     

Effect of primary-care spirometry on the diagnosis and management of COPD.

Primary-care spirometry has been promoted as a method of facilitating accurate diagnosis of chronic obstructive pulmonary disease (COPD). The present study examined whether improving rates of diagnosis lead to improvements in pharmacological and nonpharmacological management. From 1999 to 2003, the current authors provided an open-access spirometry and reversibility service to a local primary-care area, to which 1,508 subjects were referred. A total of 797 (53%) had pre-bronchodilator airflow obstruction (AFO). Of the subjects who underwent reversibility testing, 19.3% were no longer obstructed post-bronchodilator. The results and records of a subgroup of 235 subjects with post-bronchodilator AFO were examined. Of the 235 subjects, 130 received a new diagnosis, most commonly COPD. The patients with COPD were significantly undertreated before spirometry and testing led to a significant increase in the use of anticholinergics (37 versus 18%), long-acting beta-agonists (25 versus 8%) and inhaled steroids (71 versus 52%). More than three quarters of smokers received smoking cessation advice but very few were referred for pulmonary rehabilitation. In conclusion, primary-care spirometry not only increases rates of chronic obstructive pulmonary disease diagnosis, but it also leads to improvements in chronic obstructive pulmonary disease treatment. The use of bronchodilator reversibility testing in this setting may be important to avoid misdiagnosis.     

Airflow limitation is underrecognized in well-functioning older people

OBJECTIVES: Dyspnea is a common symptom in older people. A reduced forced expiratory volume in 1 second (FEV1) is associated with a higher mortality rate from cardiovascular and respiratory disease, and increased admissions to hospitals. Underrecognized or undertreated airflow limitation may exacerbate the problem. The purpose of this study was to assess the prevalence and treatment of airflow limitation in a cohort of well-functioning older people. DESIGN: Cross-sectional study. SETTING: Baseline of a clinical-epidemiological study of incident functional limitation. PARTICIPANTS: Participants attended the baseline examination of the Health, Aging, and Body Composition study, a prospective cohort study of 3,075 well-functioning subjects age 70 to 79. MEASUREMENTS: Demographic and clinical data were collected by interview. Spirometry was performed unless contraindicated and repeated until three acceptable sets of flow-volume loops were obtained. Patients on bronchodilator medications had spirometry performed posttherapy. Blinded readers assessed the flow-volume loops, and inadequate tests were omitted from analysis. Airflow limitation was defined as a reduced forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) as determined by age-, sex-, and race-normalized values. Severity of airflow limitation was defined by American Thoracic Society criteria. RESULTS: Two thousand four hundred eighty-five subjects (80.8%) had assessable spirometry and data on treatment and diagnosis (1,265 men, 1,220 women). The mean age was 73.6 years. Two hundred sixty-two subjects (10.5%) had airflow limitation; 43 (16.4%) of these never smoked. Only 37.4% of participants with airflow limitation and 55.6% of participants with severe airflow limitation reported a diagnosis of lung disease. Only 20.5% of subjects with at least moderate airflow limitation had used a bronchodilator in the previous 2 weeks. CONCLUSION: Despite their good functional status, airflow limitation was present, and underrecognized, in a considerable proportion of our older population. The low bronchodilator use suggests a significant reservoir of untreated disease. Physicians caring for older people need to be more vigilant for both the presence, and the need for treatment, of airflow limitation.     

Respiratory symptoms and undiagnosed airflow obstruction in middle-aged adults: the Korean Health and Genome Study

BACKGROUND: The prevalence of undiagnosed airflow obstruction is difficult to measure since it requires screening in population-based samples to identify individuals free of clinical symptoms. The purpose of this report is to examine the prevalence of undiagnosed airflow obstruction and its relation with respiratory symptoms in middle-age adults in the Korean Health and Genome (KHG) Study. METHODS: The KHG study is an ongoing population-based study of Korean adults aged 40 to 69 years. The current report includes 8,140 men and women without a pulmonary disorder or obstructive lung disease. In this sample, undiagnosed airflow obstruction was defined on the basis of spirometric testing and in the absence of a medical history or a recognized pulmonary disorder. Respiratory symptoms included chronic cough, chronic phlegm, wheezing, and shortness of breath. RESULTS: Undiagnosed airflow obstruction was observed in 12.4% of the men (470 of 3,806 subjects) and in 3.5% of the women (152 of 4,334 subjects). In men, the age-adjusted prevalence of undiagnosed airflow obstruction increased consistently with increasing number of respiratory symptoms. In those who smoked, there was a 2.3-fold excess in its prevalence when three or more symptoms were present, as compared to when they were absent (27.4% vs 12.0%, p < 0.001). A 2.4-fold excess (20.6% vs 8.5%, p = 0.004) was observed in nonsmoking men, in whom respiratory symptoms were consistently less common than in those who smoked. Respiratory symptoms were unrelated to undiagnosed airflow obstruction in women smokers, although only 3.9% smoked cigarettes. In women who were nonsmokers, the prevalence of undiagnosed airflow obstruction increased from 2.3% in those without a respiratory symptom to 6.0% when three or more symptoms were present (p = 0.003). CONCLUSIONS: Findings suggest that undiagnosed airflow obstruction is common in Korea with several respiratory symptoms. Whether respiratory symptoms with associations with undiagnosed airflow obstruction can be used to design early intervention strategies that prevent or delay the onset of COPD and its disabling consequences warrants further study.     

Mexican American elders have similar severities of COPD despite less tobacco exposure than European American elders

INTRODUCTION: Hispanics are the fastest growing ethnicity of the US population and the largest subset includes those of Mexican origin. Hispanics, including Mexican Americans (MAs), consistently report less tobacco exposure than European Americans (EAs), but limited data are available regarding differences in the clinical characteristics, severity of airflow obstruction, and functional status between MAs and EAs with chronic obstructive pulmonary disease (COPD). METHODS: Participants in a community-based study of aging and frailty among MAs and EAs, San Antonio Longitudinal Study of Aging, underwent spirometry. Participants with spirometry values consistent with COPD by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria are described here. RESULTS: Thirty-four percent (248/721) of the participants who underwent spirometry had evidence of GOLD Stages 1-4 COPD. Significantly more MAs with COPD reported being never smokers compared to EAs with COPD. Among those with COPD who also smoked, MAs reported significantly less tobacco exposure than EAs (15.7 vs. 32.4 pack-years, respectively), but both groups had surprisingly similar severities of airflow obstruction. Additionally, MAs had worse functional status and perceived health than did EAs. CONCLUSIONS: Despite significantly less exposure to tobacco smoke, MAs with COPD had a similar degree of obstruction to airflow compared with EAs with COPD. Healthcare providers should have a high index of suspicion for COPD in MAs who are exposed to even small amounts of cigarette smoke.     

Association between airflow limitation and prognosis in patients with chronic pulmonary aspergillosis

BackgroundPrevious studies have shown that reduced levels of lung function, characterized by forced expiratory volume in 1 second (FEV₁), are associated with higher respiratory events and mortality in general population and some chronic lung diseases. Chronic pulmonary aspergillosis (CPA) is a destructive, fatal lung disease caused by Aspergillus infection in non-immunocompromised patients with suboptimal pulmonary function. However, there is limited information on the status and features of CPA according to FEV₁.MethodsWe performed a retrospective observational study to investigate the FEV₁ and airflow limitation in patients with CPA between March 2017 and February 2019 at a tertiary hospital in South Korea.ResultsOf the 144 CPA patients, 104 underwent spirometry, demonstrating median forced vital capacity (FVC) and FEV₁ of 2.35 L (68%) and 1.43 L (62%), respectively. Among them, 56 patients had airflow limitation on PFT, with median FVC, and FEV₁ of 2.47 L (73%) and 1.11 L (47%), respectively. Low body mass index (BMI) (20.1 vs. 22.1 kg/m²; P=0.011), breathlessness (60% vs. 20%; P=0.002), and bilateral pulmonary lesions (33.3% vs. 4%; P=0.006) were more common in patients with moderate to very severe airflow limitation than in those with normal to mild airflow limitation.ConclusionsModerate to very severe airflow limitation was observed in 43.3% of patients with CPA. Additionally, low BMI, breathlessness, and bilateral pulmonary lesions contributing to poor prognosis were more common in patients with moderate to very severe airflow limitation than in those with normal to mild airflow limitation. Our findings suggest that airflow limitation can be associated with the prognosis of CPA. Further investigations are needed to demonstrate the clinical significance of this association.     

Breathlessness and Skeletal Muscle Weakness in Patients Undergoing Lung Health Screening in Primary Care

Abstract

Earlier diagnosis of COPD is a major public health challenge as symptoms may be attributed to the normal consequences of aging. The optimum strategy for identifying patients with COPD remains to be determined. People aged 35 and over (n = 1896) on a GP practice register were randomised to either invitation or an opportunistic lung health check which included spirometry, quadriceps strength and MRC dyspnoea score. Then, 101 participants subsequently completed the General Practice Physical Activity Questionnaire. A total of 335 attended over a 15-week period; 156 were in the invitation group and 179 from the opportunist group. In 25 persons, spirometry was unsatisfactory or contraindicated. Spirometry was normal in 204(65.8%) and restrictive in 36(11.6%). 70(22.6%) had airflow obstruction, corresponding to Global Initiative for Chronic Lung Disease (GOLD) stages I-IV in 18(5.8%), 35(11.3%), 14(4.5%) and 3(1.0%), respectively. The opportunist group were significantly more likely to have airflow obstruction 30.1% vs 14.3% (p = 0.001). Breathlessness was reported commonly (40.5%) and quadriceps strength correlated significantly with MRC dyspnoea score independent of age, sex, pack-years smoked, fat-free mass and FEV₁ percent predicted. This relationship was also present in the subgroup of healthy participants (n = 143). 51.5% of participants screened were classified as “inactive” and this group were weaker and more breathless than those who were more active. Airflow obstruction was more common in those screened opportunistically. Breathlessness and inactivity are common in patients taking part in spirometry screening. Breathlessness is significantly associated with leg strength independent of spirometry and should be amenable to interventions to increase physical activity.     

Postoperative chest infection after upper abdominal surgery: an important problem for smokers.

The incidence and risk factors for postoperative chest infection have been studied in 127 patients undergoing elective upper abdominal surgery. The overall incidence of postoperative chest infection was 20.5%. Mean length of postoperative stay was extended from 7.8 to 10.7 days in those developing infection (P less than 0.05). Patients who smoked cigarettes and those with smoking related diseases had a considerably higher risk of infection. Patients with chronic bronchitis and airflow obstruction had an incidence of infection of 85.7%, those with chronic bronchitis alone 83.3% and those with airflow obstruction and no chronic bronchitis 50%. Patients with a smoking history of greater than or equal to 20 pack years but no chronic bronchitis or airflow obstruction had an incidence of 20.8%. All three were independently significant risk factors for infection. Patients without respiratory disease and who were non-smokers had an incidence of infection of only 7.1%. Smoking and its sequelae are the principal risk factors for postoperative chest infection. This study shows that the high risk patient can readily be identified by enquiry into respiratory symptoms, smoking history and by spirometry. This is the group in whom prophylactic measures are especially important, and they require close supervision to enable early identification and therapy of infection.     

Light smoking and dependence symptoms in high-school students

In high-school students, prevalence of smoking is high but few studies analyzed smoking in the student population according to nicotine content of smoked cigarettes and gender. We analyzed the responses to a questionnaire, including the modified Fagerstr?m Tolerance Questionnaire (FTQ), administered to 555 students (382 males, 173 females) of a professional high school in Palermo, Italy, to assess the prevalence in both genders of: (1) smoking "light" and high nicotine (HN) cigarettes; (2) signs of nicotine dependence and (3) respiratory symptoms. Nicotine content of habitually smoked cigarettes was considered as "light" if 0.8 mg; as high if >0.8 mg. Forty-four percent of students smoked, without differences between genders. Two-thirds of the total sample reported "light" cigarette smoking (76.7% of females vs. 62.0% of males, P<0.05). On average, "light" cigarette smoking was associated with lower pack/year and FTQ global score compared to HN smoking. However, when FTQ global score was analyzed by taking into account pack/year, no major difference was found between "light" and HN cigarette smokers. Cough with phlegm and breathlessness were more frequently reported by smoking than non-smoking students, without differences between "light" and HN cigarette smokers. About 50% of smoking students reported having tried to quit, while only 3.4% of students were ex-smokers. "Light" smoking was common in high school students, especially among females. Dependence appeared more influenced by the smoking history than by nicotine content. Respiratory symptoms were similar in "light" and HN cigarette smokers.     

Prevalence of Airflow Obstruction as Measured by Spirometry,in Rural Southern Indian Adults

Abstract

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu.

A cross sectional survey was done in nine villages, among adults aged ≥30?years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1?s/Forced Vital Capacity (FEV1/FVC)?<?Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria.

Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%–9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC?<?LLN) was 4.6% (95% CI: 3.1%–6.1%, 36), and 4.1% (95% CI: 2.7%–5.5%, 32) using post bronchodilator FEV1/FVC?<?70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year.

This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms.     

Oscillatory mechanics of the respiratory system in neuromuscular disease.

Respiratory impedance measurements by means of the technique of forced oscillations together with spirometry and measurements of maximal mouth pressures were performed in 27 patients with a variety of neuromuscular disorders to assess the value of adding respiratory impedance measurements in the evaluation of lung function in neuromuscular disease. Using the technique of forced oscillations, impedance measurements are easily performed in physically disabled persons, since they require little active cooperation and no forced respiratory maneuvers. Normal respiratory impedance characteristics were found, although resistance values were somewhat higher than those found in normal subjects, signifying the absence of airflow limitation. Spirometric values were markedly reduced, as were maximal mouth pressures. No significant correlations were found between the forced expiratory volumes in 1 s (FEV1) and the impedance data. A strong curvilinear relationship was observed between Pemax and the RV/TLC ratio and a strong correlation existed between FEV1 and Premax. It is concluded from our study that forced oscillometry is a useful tool for the assessment or exclusion of airflow obstruction in patients with neuromuscular disorders when plethysmography is difficult to perform and forced expiratory flow-volume data reflect muscle weakness rather than airflow limitation.     

Gender and chronic obstructive pulmonary disease in high-risk smokers

BACKGROUND: Data suggest that women are more susceptible to develop airway obstruction compared to men for the same number of cigarettes smoked. OBJECTIVES: To compare the prevalence of chronic obstructive lung disease (COPD) and the effect of smoking on the risk of developing COPD according to gender, in a population of high-risk smokers. METHODS: In 795 smokers, spirometry was performed using the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to determine airflow obstruction. COPD prevalence was determined in smokers grouped according to the number of cigarettes smoked per year [<20 (I), 20-40 (II), 40-60 (III) and >60 pack-years (IV)] and age. RESULTS: Men were older, smoked more and for a longer period. Age at smoking initiation and the number of packs smoked per day did not differ. COPD was diagnosed in 26% of the subjects (30.5% men and 22.3% women, p < 0.001) with similar degree of obstruction (forced expiratory volume in 1 s: 78% of predicted in men vs. 75% in women). COPD prevalence was lower in women in all categories irrespective of the pack-year history (I: 9 vs. 19%; II: 16 vs. 28%; III: 28 vs. 39%, and IV: 25 vs. 42%, respectively, p < 0.001). In those older than 50 years, 34% men and 17% women (p < .001) had COPD. CONCLUSIONS: Using the GOLD criteria, the prevalence of COPD in smokers was higher than previous reports. In this self-selected sample of high-risk smokers having the same smoking history, prevalence was lower in women than in men, suggesting a lower susceptibility for the development of airway obstruction.     

Impact of airflow obstruction on long-term mortality in patients with asthma in Japan

BackgroundThe long-term prognosis of asthma with airflow obstruction is poorly understood in Japan. The aim of this retrospective 26-year study was to investigate the long-term mortality risk of airflow obstruction in asthmatics.MethodsUsing data from the Omuta City Air Pollution-related Health Damage Cohort Program, mortality risk ratios of airflow obstruction in Japanese Individuals were analyzed by Cox proportional hazards models. Airflow obstruction was considered to be present when the forced expiratory volume in 1 sec (FEV₁)/forced vital capacity ratio was <0.7 and FEV₁ predicted was <80% based on spirometry.ResultsAmong the 3146 victims with chronic respiratory diseases, 697 with adult asthma were selected. Median follow-up period was 26.3 (range 0.9–40.9) years. The airflow obstruction group (n = 193) showed significantly higher rates of mortality related to respiratory problems (risk ratio [95% confidence interval] 1.51 [1.86–1.93], P = 0.0017) and asthma attacks (1.86 [1.30–2.66], P = 0.0011) than the without airflow obstruction group (n = 504). Airflow obstruction was an independent risk factor for both respiratory-related (1.84 [1.36–2.49], P = 0.0001) and all-cause (1.44 [1.17–1.76], P = 0.0008) mortality after adjustment for age, sex, body mass index, and smoking status. More severe airflow obstruction was significantly associated with poorer prognosis.ConclusionsThis long-term cohort program revealed the impacts of asthma with airflow obstruction as an independent mortality risk. Findings suggest that intervention and prevention of airflow obstruction can reduce long-term mortality in patients with asthma.     

Passive smoking in childhood. Respiratory conditions and pulmonary function in Tecumseh, Michigan

The relationship of passive smoking to respiratory conditions and pulmonary function was assessed using a cross-sectional design in the defined population of Tecumseh, Michigan. The study population was made up of 3,482 children who were 0 to 19 yr of age at the 1962-1965 examination and for whom questionnaire information was available for both parents. Nearly 62% of children in this age group were exposed at the time of examination to at least 1 parent who smoked. Passive exposure to cigarette smoke was associated with an elevated prevalence of phlegm, wheeze, asthma, and chest colds among males and wheeze, bronchitis, and chest colds among females. Using logistic regression, offspring were shown to be 1.5 to 2.0 times more likely to have a respiratory condition if both their parents currently smoked than if both parents never smoked. FEV1, and FVC among males and Vmax50 among females were significantly lower by 5% in nonsmokers 10 to 19 yr of age whose parents were current smokers compared with similar offspring of never smoking parents. Respiratory conditions were generally more frequent and the level of lung function was generally lower for males from households where only mothers smoked compared with males from households where only fathers smoked, although sample size was limited. In females similar relationships were less consistent. Differences tended to be larger and more often significant for males than for females when respiratory symptoms and illnesses were examined.(ABSTRACT TRUNCATED AT 250 WORDS)     

The significance of wheezing in chronic airflow obstruction

Eighty-three patients with chronic airflow obstruction were examined prospectively to determine the relationships among wheezing intensity, severity of obstruction, and response to inhaled isoproterenol. For each patient, expiratory wheezing scores were assigned during deep unforced breathing and during forced vital capacity efforts at spirometry. Unforced wheezing scores were independently correlated with severity of obstruction (r = 0.42) and bronchodilator response (r = 0.46), but these correlations did not permit consistent prediction of either variable for clinical purposes. The highest wheezing scores, however, were uniformly associated with moderate or severe obstruction. Twenty-nine of 48 patients with wheezing but only 3 of 35 patients without wheezing demonstrated 15% or greater improvement in one-second forced expiratory volume after bronchodilator inhalation (p less than 0.001). Wheezing during forced exhalation was not correlated with either degree of obstruction or bronchodilator response.     

Implementation of a targeted screening program to detect airflow obstruction suggestive of chronic obstructive pulmonary disease within a presurgical screening clinic

BACKGROUND:Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE:The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS:The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS:After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS:Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.