Written by Peter Liu
Spoon Feed
In patients initiating treatment for obstructive lung disease, only 20.9% of patients received timely spirometry testing, which was associated with a 34% decrease in mortality risk.
Timely spirometry saves lives
In real-world medical settings, the practice of diagnosing or treating obstructive lung disease without timely spirometry is common and rife with misdiagnosis. One Italian study estimates 25-40% of COPD or asthma diagnoses are made without spirometry. Additionally, when these patients undergo spirometry, results often conflict with their diagnosis (around 13% for patients with COPD).
A recent Belgian retrospective cohort study shows why this is significant. Using nationwide healthcare data (2017–2020) including 146,205 adults, the study evaluated whether timely spirometry at initiation of chronic respiratory treatment reduced all-cause mortality. In patients that received at least two packages of medications for obstructive lung disease, the study tracked whether spirometry testing was performed before the receipt of the second package of medication (timely spirometry) or not. Of these patients, only 20.9% underwent timely spirometry. Those who did had a 34% lower mortality risk (aHR 0.66; 95%CI 0.63–0.70). Female sex, age under 60 or over 80, frailty, and low socioeconomic status were negatively associated with spirometry use. Timely spirometry predicted better survival across all subgroups.
This retrospective study likely includes confounding factors not well-captured by available data. While an RCT with similar findings would offer clear evidence, these findings strongly suggest that early spirometry improves survival, and we may be doing our patients a disservice by under-utilizing them.
How does this change my practice?
It is very satisfying to treat a disease empirically, and I have found immense joy in relieving symptoms of wheezing and dyspnea by prescribing steroids and inhalers in the hospital for patients with clinical presentations of COPD or asthma, even when they do not yet have a formal diagnosis. I am now motivated to think farther into the future for such patients, and to ensure timely access to confirmatory testing of obstructive lung disease.
Source
Timely Spirometry is Associated with Lower All-Cause Mortality: a Nationwide Obstructive Cohort Study. Chest. 2025 Mar 28:S0012-3692(25)00409-X. doi: 10.1016/j.chest.2025.03.018. Epub ahead of print. PMID: 40158845
