Office Spirometry: Indications and Interpretation

Approximately 1% to 4% of all visits to primary care offices are for dyspnea.1 The proper use of pulmonary function tests can help differentiate many of the causes of dyspnea, monitor the progression of chronic pulmonary disease, and assess response to treatment. In a cross-sectional study, primary care physicians underestimated the severity of chronic obstructive pulmonary disease (COPD) in 41% of patients and overestimated severity in 29% of patients when compared with immediate, in-office spirometry. Overall, physician rating of severity was accurate in only 30% of patients.2 Spirometry is recommended as part of the diagnostic workup in patients with presumed COPD or asthma by the American Thoracic Society/European Respiratory Society (ATS/ERS)3; the Global Initiative for Chronic Obstructive Lung Disease (GOLD)4; the Global Initiative for Asthma5; and the American Academy of Allergy, Asthma, and Immunology.6 High-quality spirometry performed in a family physician's office is comparable to testing performed in a pulmonary function laboratory.7,8 A video of office-based spirometry is available at https://bit.ly/2JAIYGx. Although there are different types of pulmonary function tests, this article focuses on office-based spirometry.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	Comments
Spirometry is recommended as part of the diagnostic workup in patients with presumed COPD or asthma.3–6	C	Expert opinion from national and international organizations (ATS/ERS; Global Initiative for Chronic Obstructive Lung Disease; Global Initiative for Asthma; and American Academy of Allergy, Asthma, and Immunology)
Screening for COPD with spirometry is not recommended in asymptomatic adults.10	C	U.S. Preventive Services Task Force found no studies that directly assessed the effect of screening in asymptomatic adults on morbidity, mortality, or health-related quality of life
Full pulmonary function testing should be performed in patients with a restrictive pattern on spirometry and in patients with a mixed pattern if the forced vital capacity does not improve significantly after administration of a bronchodilator.15	C	Expert opinion from ATS/ERS
Bronchoprovocation testing should be performed in patients with normal results on pulmonary function testing but a history that suggests exercise- or allergen-induced asthma.25	C	Expert opinion from ATS/ERS

ATS = American Thoracic Society; COPD = chronic obstructive pulmonary disease; ERS = European Respiratory Society.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C =...