GOAL 1. Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD.

While it has long been known that poor lung function can predict a coronary event, it was uncertain if different patterns of lung deterioration had the same ability to predict such events, whether non-fatal or sudden death.

The study that Suneela Zaigham et al. conducted, considered an analysis that included the adjustment of potential factors. This is what they found: 

• 1 standard deviation reduction in FEV₁ was associated with a Hazard Ratio (HR) for Sudden Cardiac Death of 1.23 (95% Confidence Interval (CI) 1.15 - 1.31).

•   However, 1 standard deviation in FEV₁ was associated with a lower (but significant) risk of non-fatal events with a Hazard Ratio (HR) of 1.08 (95% CI, 1.04 – 1.13; P (probability) for equal associations = .002).
• ·  The results were the same among participants who had never smoked, with a Hazard Ratio for Sudden Cardiac Death of 1.34 (95% Confidence Interval, 1.15 – 1.55). The HR for non-fatal events was 1.11 (95% CI, 1.02 – 1.21; P (probability) for equal associations =.038). 

Those figures show a higher risk of fatal coronary events than non-fatal ones, even in people whose lung function was slightly below the normal range (but still considered normal). Therefore, this suggests that there exists a relationship between lung health and Sudden Cardiac Death.

In fact, Dr. Zaigham reported that a low FEV₁ was indeed associated with both, Sudden Cardiac Death, and non-fatal coronary events; but in addition, a low FEV1 was strongly associated with the prediction of Sudden Cardiac Death.

She also suggests taking advantage of spirometry early in life, as this simple test can go a long way in stratifying the risk of Sudden Cardiac Death. In other words, the use of spirometry is a great tool to reduce cardiovascular risks.

Reference

As you know, the effects of this problem are devastating for patients on a physical, emotional, and economic level. Comorbidities, such as osteoporosis and cardiovascular problems that affect the patient's (and their family's) life, often occur, leading to depression. And on the economic side, it is estimated that the costs, direct and indirect, for the U.S. health system reach 36 billion dollars annually.  

This makes it clear that having a good management of this disease results in an enormous improvement in the well-being of patients, the hospital system, society and for you, as a health professional. Unfortunately, one of the most useful and effective tools to achieve this is often undervalued, and therefore underused: spirometry.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD), in its 2020 report, emphasizes how important it is that the first contact physician to be able to detect the disease to immediately refer the patient, so the specialist can provide appropriate treatment and management of COPD on time.

As you know, individuals who require spirometry for diagnosis/evaluation of their pulmonary function are as follows:

• Patients with recurrent respiratory events. For example, acute bronchitis, undertreated flu, chronic coughs, or people with excessive sputum production.
• Patients with a history of exposure to risk factors. That is, smokers, former smokers, passive smokers, patients with alpha-1-antitrypsin deficiency and occupational exposuretodust, vapors, organic and chemical materials.
• Subjects with limited physical activity due to dyspnea.
• People with a family history of COPD.

The fact that the first contact physician indicates routine spirometry or, as the case may be, body plethysmography, speeds up diagnosis, which is vital in the long term for assessing response to treatment, medication adjustment, and monitoring disease progression.

A relationship between FEV₁/FVCperformed 15 minutes after inhalation of a Short-Acting Beta-Agonist SABA bronchodilator (salbutamol, albuterol)<0.70 confirms the existence of a persistent or fixed limitation to airflow. And this can only be known with certainty by spirometry.

Despite the recommendations of various international organizations, spirometry remains underutilized in primary clinical practice. In general, its limited use is attributed, on the patient’s side, to ignorance about the benefit of the early diagnoses of the disease, to lack of time and/or resources. Or to the lack of familiarity with the technique and interpretation process on the side of the primary care physicians.

Although patients may be referred to the specialist for diagnosis, follow-up in those circumstances will always be limited due to late detection. By the time COPD is diagnosed, the patient has already gone through incorrect treatments or has already lost valuable time that may have improved the prognosis and management of the disease.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886101/

The growing demand for pulmonary function testing due to the COVID-19 pandemic has lead many physicians to consider renewing their spirometers or acquiring more units. And even doctors who previously did not offer this test are deciding to get spirometers to provide better care to their patients from the first appointment. 

Whatever your reasons for buying equipment, here are some practical tips to help you make the best decision.

In Schiller, we have SpiroScout an ultrasonic spirometer that covers the points mentioned above. One of its big strengths in times of pandemic is that it avoids cross-contamination because:

• It uses our unique ScoutTube mouthpiece, which isolates the patient's exhalation and avoids contact with the device´s sensors.
• The device can also use a high-efficiency PFT filter, which is a must nowadays.
• The health care professional can perform the test while maintaining the distance recommended by CDC (Centers for Disease Control and Prevention)