Increased utilization of spirometry: The solution to both mis- and underdiagnosed lung conditions
Table of contents
Spirometry is crucial for accurately diagnosing lung conditions
Spirometry is a common pulmonary function test used to evaluate the health of a person’s lungs. There are many parameters generated from a spirometry test. Three are primarily used in the clinic: Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the ratio of FEV1 to FVC (FEV1/FVC).* Spirometry is used to deduce whether a person first demonstrates a possibility of lung disease. Based on the FVC, FEV1, and FEV1/FVC values, trained clinicians can then discern whether the patient has restrictive or obstructive patterns of lung disease.* Spirometry, like many tools, is not the only instrument clinicians should use to diagnose a patient presenting with symptoms such as shortness of breath.* Instead, spirometry should be used as a first line of inquiry intended to guide next steps.
Spirometry is an essential component for diagnosing lung diseases. The test is used in the diagnosis and management of chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, pulmonary fibrosis, emphysema, bronchiectasis, and even some forms of lung cancer, all conditions which present with different constellations of symptoms and spirometric signatures.* Spirometry is even required by Occupational Safety and Health Administration (OSHA) to screen workers for job assignments and monitor workers for potential exposure-related health effects.
There is a crisis of under- and misdiagnosed lung conditions
While the journey of patients managing their chronic, progressive lung condition becomes dramatically different once they receive a diagnosis, that’s not where it begins. Some patients might not even begin with spirometry. For many patients, their journey begins years prior to their diagnosis, many of whom are seeing multiple specialists and even receiving multiple diagnoses — or never receiving one — before getting an accurate one. There are ramifications related to delayed diagnoses, burdening the patient’s body and their mind as they navigate appointments, tests, and therapies. One study found that school-aged children with undiagnosed asthma had more than seven absences from school in the previous year compared to their healthy peers.* Another study found adults with undiagnosed asthma had poorer quality of life than their peers.* It’s only reasonable to suspect that these consequences are paralleled in other conditions, underscoring the importance of adequately diagnosing patients.
Unfortunately, a great deal of people live with undiagnosed or misdiagnosed lung diseases, with estimates ranging up to 95% of global cases of COPD remaining undiagnosed.* This extremely high figure raises concern about how many people are living with COPD without receiving adequate treatment. It is also concerning that the prevalence of conditions is not truly known due to a large percentage of true cases not counted as well as an overcounting because of misdiagnoses. Positively, many studies point to the same culprit for both issues: An underutilization of spirometry. *
Spirometry underutilization is widespread, both geographically and in the clinic: Spirometry is underutilized in primary and specialized care and in hospitals in at least the United States, Malaysia, Spain, and Italy.* The authors of one paper investigating the significance of this problem capture the magnitude of this problem: “Not performing spirometry is the strongest predictor for an incorrect diagnosis of COPD.”*
Why is spirometry so underutilized and how can we increase spirometry utilization?
Even though spirometry is well-established as the standard to confirm diagnoses for many lung diseases, logistical and systemic issues such as lack of access to resources, expensive spirometry devices, general confusion, and conflicting guidance within the field are just some of the barriers to increased utilization of spirometry.*Additionally, older patients, those who are not receiving pulmonary care, and patients with fewer comorbidities are less likely to perform spirometry.*
Fortunately, with the advent of portable, easy to use, point of care devices like EasyOne Air, access to accurate spirometry devices is becoming less of an issue. Still, other barriers remain and must be resolved. Global awareness of the significance of spirometry must be covered more loudly and broadly than it is in the present alongside more consistency in guidance documents. Improved education is another part of the solution too, with senior doctors educating junior physicians on the importance of using spirometry as part of a systematic diagnostic approach. Studies in the US and Italy have corroborated findings that with increased training and education and the routine use of spirometry, the detection of currently significantly under-diagnosed airway obstruction in hospitalized patients would improve.*
Spirometry underutilization is a rampant global issue leading to legions of misdiagnosed and undiagnosed patients. With increased access to portable devices, increased and improved education and teaching of medical professionals, and with better awareness of how spirometry is required in the diagnosis of many lung conditions, there will be a profound shift in the way lung conditions are diagnosed and treated around the world.
Tré LaRosa is a consultant, scientist, and writer in the Washington, DC area with extensive experience working in research (basic, translational, and clinical) and on patient-reported outcomes. He has also written extensively on neuroscience, pulmonology, and respiratory conditions, including from the patient perspective. He enjoys learning, reading, writing, spending time outdoors, and telling everybody about his mini golden retriever, Duncan.
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