A retrospective study of two populations to test a simple rule for spirometry

BMC Family Practice

Research Article

Jill A. Ohar¹  Barbara P. Yawn²  Gregg L. Ruppel³  James F. Donohue⁴ 

[1] Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, 27157-1054, Winston-Salem, NC, USA;Department of Research, Olmsted Medical Center, 55904, Rochester, MN, USA;Pulmonary, Critical Care & Sleep Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA;University of North Carolina Chapel Hill, Chapel Hill, NC, USA;

关键词: COPD;    Spirometry;    Smoking;    Respiratory symptoms;   

DOI  :  10.1186/s12875-016-0467-2

 received in 2015-07-02, accepted in 2016-05-23,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundChronic lung disease is common and often under-diagnosed.MethodsTo test a simple rule for conducting spirometry we reviewed spirograms from two populations, occupational medicine evaluations (OME) conducted by Saint Louis and Wake Forest Universities at 3 sites (n = 3260, mean age 64.14 years, 95 % CI 58.94–69.34, 97 % men) and conducted by Wake Forest University preop clinic (POC) at one site (n = 845, mean age 62.10 years, 95 % CI 50.46–73.74, 57 % men). This retrospective review of database information that the first author collected prospectively identified rates, types, sensitivity, specificity and positive and negative predictive value for lung function abnormalities and associated mortality rate found when conducting spirometry based on the 20/40 rule (≥20 years of smoking in those aged ≥ 40 years) in the OME population. To determine the reproducibility of the 20/40 rule for conducting spirometry, the rule was applied to the POC population.ResultsA lung function abnormality was found in 74 % of the OME population and 67 % of the POC population. Sensitivity of the rule was 85 % for an obstructive pattern and 77 % for any abnormality on spirometry. Positive and negative predictive values of the rule for a spirometric abnormality were 74 and 55 %, respectively. Patients with an obstructive pattern were at greater risk of coronary heart disease (odds ratio (OR) 1.39 [confidence interval (CI) 1.00–1.93] vs. normal) and death (hazard ratio (HR) 1.53, 95 % CI 1.20–1.84) than subjects with normal spirometry. Restricted spirometry patterns were also associated with greater risk of coronary disease (odds ratio (OR) 1.7 [CI 1.23–2.35]) and death (Hazard ratio 1.40, 95 % CI 1.08–1.72).ConclusionsSmokers (≥ 20 pack years) age ≥ 40 years are at an increased risk for lung function abnormalities and those abnormalities are associated with greater presence of coronary heart disease and increased all-cause mortality. Use of the 20/40 rule could provide a simple method to enhance selection of candidates for spirometry evaluation in the primary care setting.

【 授权许可】

CC BY   
© The Author(s). 2016