Recently, several medical associations released a new set of guidelines for diagnosis and management of COPD.
A common controversial topic has been the use of spirometry for screening COPD. Under the acknowledgement that COPD is on the rise and that respiratory symptoms are common in our society, the big question is if we need to look for spirometry results to “screen” for COPD.
The statement: Spirometry only for the symptomatic
According to these guidelines “Spirometry should be used to diagnose and determine the severity of airflow obstruction, but only in patients with respiratory symptoms (evidence grade: strong)”.
The only issue with this perspective is that most patients with COPD in their early stages prefer to disregard their symptoms or even hide them.
Then, a huge number of patients might not be informed properly about their health because they are not going through further evaluations (e.g. spirometry).
Unfortunately, the spirometry might also result in false positive diagnoses for other patients leading to inappropriate or unnecessary treatment. It is then when a combination of trust and good clinical judgment is required. A transparent communication of symptoms as well as the good clinical analysis and association of these symptoms to search for a diagnosis, can lead to the right decisions.
Where are the symptoms? (Where is Waldo?)
Communication comes to the desk again. Once the relationship between physician and patient is open, the patient has to concede space to the trust and talk about breathlessness during physical activity, cough in the morning, sputum production. These are common symptoms that patients think that are not abnormal and the idea of acceptance of them would imply the label of “illness”. The physician has also to look for these symptoms, assess and define their relevance and orientate the judgment to the use of additional tools for confirmation of diagnosis when necessary.
Without fear but cautious
There is a general evolution in the understanding of the disease. Although a statement like “Spirometry should be used to diagnose and determine the severity of airflow obstruction, but only in patients with respiratory symptoms” may be confusing, patients and physicians have to take it carefully.
Recognize the symptoms, look for them, go through a good physical examination, and, under good environment for decisions, consider the spirometry to confirm the diagnosis.