By Dr. Alan Palmer
Spirometry is the only test available to the primary care physician for the early detection of COPD, when it is most amenable to treatment and perhaps reversal. If this statement is true, why is it not being used more? Dr. Charles Irvin of the Vermont Lung Center asked this question in his paper entitled “To Blow or Not to Blow – That is the question” (Respiratory Care Journal 10.02). He states there are four perceived problems that keep physicians from using spirometry:
- Spirometry is a poor test. This criticism reflects the lack of education on the part of the physician community. The National Lung Health Program’s recent paper states that spirometry is one of the best clinical tests available for detection of lung disease and is better than Blood Pressure as a predictor for heart disease. Cleary, Spirometry is not only a good test, but an outstanding test.
- The equipment is bulky and expensive. This may have been true at one time, but not now. With the introduction of flow and ultra sonic spirometers that are comparatively smaller and meet all performance specifications; there is no excuse for not offering this test coupled with the fact that equipment is now available for less than $2000. Therefore, the bulkiness issue and cost barriers are gone.
- Spirometry is a hard test to administer. It does require that those administering the test undergo spirometry training so that they can give and quality control the test correctly. It also requires a reasonable amount of cooperation from the subject being tested, yet it only takes about 10 minutes to perform.
- Doctors don’t understand what the test numbers mean. Since physicians receive little instruction in spirometry during their medical training, this criticism may be factual. Where they may order and review the electrocardiogram test with confidence, they are reticent to order spirometry testing because of their lack of understanding when doing the interpretation. Because mortality during lung disease is ranked #4 and COPD is under-diagnosed, there is a need to educate the physician community on the value of the test.
Dr. Alan Palmer