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Smoking History, Not Symptoms, Predictive of COPD

Doing spirometry on those with symptoms adds little to strategy of screening older smokers

FRIDAY, June 4 (HealthDay News) -- Even though about half of all cases of chronic obstructive pulmonary disease (COPD) are undiagnosed, selecting symptomatic people for spirometric screening adds little to the strategy of screening older smokers, according to research published in the June issue of Chest.

Jill A. Ohar, M.D., of Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues reviewed data on 3,955 patients undergoing an employment-related medical screening. Data reviewed included smoking history, assessment of respiratory symptoms, and spirometric evidence of airway obstruction.

The researchers found that 44 percent of the smokers in the group had spirometric evidence of airway obstruction, but only 36 percent of these had ever received a diagnosis of COPD. Respiratory symptoms were reported by 92 percent of those with airway obstruction diagnosed by spirometry, but they were also reported by 86 percent of smokers with restrictive airway disease, 76 percent of smokers with normal spirometry, and 73 percent of nonsmokers. The authors conclude that, due to the high prevalence of symptoms and their poor predictive value, a more effective approach would be to screen all older smokers with spirometry, regardless of symptoms.

"At the population level, assessment of symptoms did not add to the value of smoking history in finding COPD cases. This observation underpins the idea that smokers at risk for COPD should undergo pulmonary function testing," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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