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Testing for Lung Disease: Screening Options and Next Steps

Posted Sep 22 2008 10:39pm

I had my first colonoscopy last week. How was it? Well, pretty much just like they say, meaning that the procedure itself (not that I remember a single second of it, which was just fine with me) wasn’t bad at all – but the hard part was the prep. Actually, though, I was greatly impressed with the efforts put into the entire process, from the scheduling, to the detailed information mailed to me, the calls from the pre-testing people making sure I remembered the appointment and completely understood the preparation routine; and, of course, when I arrived at endoscopy, the professionalism of the seven or so people who did their jobs so well.

When all was said and done and I was on my way home – albeit a bit foggy in the head – I was thinking about medical screening in general and Katie Couric, in particular, and how she turned the heartbreak of losing her husband into something extremely positive by raising awareness of colon cancer and the importance of colonoscopy screening.

The Bigger Picture


Okay, by now you’re looking up at the top of this page to see how in the world you landed on HealthCentral’s IBD (inflammatory bowel disease) page when you thought you had clicked on Stop Smoking/COPD. Well, my friend, stay with me because we’re getting to that right now.

Seeing all the effort that goes into a successfully completed colonoscopy screening, (which my primary care doc told me I should have because of my age), I couldn’t help but wonder how many lives could be saved and quality of life improved if even a fraction of this effort was put into pulmonary function screening for COPD. And for PF testing, both forms of it (Spirometry as well as Complete Pulmonary Function), you don’t have to miss a day of work, be on clear liquids and bowel cleansing for 24 hours, run to the bathroom all evening and through the night, have an intravenous line inserted, or require a highly trained staff of some seven health care professionals including a physician, an anesthesiologist, and the use of a surgical suite.

A No-Brainer?


Saving lives and helping people live a lot healthier with a relatively inexpensive, non-invasive (nothing is put into your body), and easy-to-perform medical test. Hmmm…sounds like a no-brainer. Again, pulmonary function testing can be done in a hospital out-patient lab, a clinic, or a physician’s office by one specially trained technician or therapist. No change in diet, time off from work (most labs now have evening hours), IV’s, or anesthesia required! What a concept. Think about it. Why would your physician not do this screening for people who are at risk for lung disease? Could it have something to do with the fact that most (but not nearly all) COPD is caused by cigarette smoking?

The Facts


Let’s take a minute to compare some disease facts for chronic lung disease and three big cancers. Now, before you say we’re comparing apples to oranges, chronic disease to cancer, let’s remember that cancer, as increasing treatable as it is, is now actually being considered a chronic disease. Bottom line – they are all major killers. We’ll start on a somber note and look at death rates, three cancer deaths for men and women, one lung-related, along with deaths from COPD.

2008 Estimated U.S. Deaths
Source: The Centers for Disease Control

  • Lung & bronchus cancer: 161,775
  • COPD: 130,933
  • Colon & rectum cancer: 47, 967
  • Breast cancer (men and women): 41, 293

    How do we screen for these diseases?


    Here’s a pop quiz. Quick: How do we screen for these diseases?
    Colon cancer? Breast cancer? Lung Cancer? COPD?

  • Colon cancer – colonoscopy
  • Breast cancer – mammogram and self-breast exam
  • Lung cancer – chest x-ray or CT, pulmonary function testing, biopsy, and more
  • COPD – pulmonary function testing

If you are already familiar with pulmonary function testing, good for you! If you’re not, and are wondering if you meet the screening criteria for COPD read on and see what you should know. My husband was once a heavy smoker. Due to my urging, he actually had a pulmonary function screen each year, and for a long time when he “blew the loop,” as he described the flow-volume loop graph that is produced by the test, his score was great. For a few years it was actually over 100% as expected. But – when his numbers dipped into the 80-90 percent range, oh boy, he started thinking seriously about quitting. You can’t argue with numbers, and eventually he did quit.

So, how do you know if you should have a pulmonary function screen? Ask yourself the following questions:

  • Are you 40 years old or older, currently smoke cigarettes or have smoked in the past?
  • Are you 40 years old or older and have a history of breathing irritants in your home environment or work place?
  • Do you sometimes have coughing fits or trouble breathing when exerting?
  • Do you have frequent bouts of bronchitis?
  • Do you cough up mucus or phlegm in the morning?
  • Does asthma, bronchitis or emphysema run in your family?
  • Do you sometimes have trouble keeping up with people your own age?
There are two main levels of pulmonary function testing: a pulmonary function screen (or spirometry), and a pulmonary function complete. To arrive at an accurate diagnosis of COPD, spirometry is usually sufficient.
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