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THE ROLE OF SCREENING SPIROMETRY IN THE EARLY IDENTIFICATION OF OBSTRUCTIVE LUNG DISEASE IN AN INNER CITY ADULT POPULATION

Vancouver Coastal Health Authority, Vancouver, BC, Canada

PURPOSE: To determine the role of screening spirometry in a high-risk inner city population for early identification of obstructive lung disease (OLD). We hypothesized that inner city adult smokers may have a high prevalence of undiagnosed OLD and have irreversible airflow obstruction before 40 years of age as a possible result of health risk factors associated with low socio-economic status and multi-inhaled substance use.

METHODS: Cross-sectional survey of an incidental sample of 300 adult cigarette smokers recruited through community gathering places in Vancouver’s inner city. Spirometry and an interviewer administered questionnaire.

RESULTS: Participants ranged in age from 30 to 74 years (mean 45.7 years; SD 7.8) and had a mean smoking history of 33 pack/years (range 2.5-110.0). Participants reported a high prevalence of respiratory symptoms: chronic cough (64%), chronic sputum (62%), wheezing (59%) and shortness of breath with activity (69%). A past or current history of smoking another inhaled substance was common (marijuana 45%, cocaine 36%). The prevalence of OLD was 10.7% based on the CTS criteria and 31% based on the GOLD or ATS/ERS criteria. Mild obstruction was found in 7.7% or 21.1% of all participants and severe obstruction in 1.8% or 1.1% based on the CTS and the GOLD or ERS/ATS criteria respectively. The prevalence rate of airflow obstruction (30.2%), defined by a FEV1/FVC ratio < 70%, in participants 34 to 39 years of age was not significantly different from the rate (32.9%) in participants 40 years of age or older (p=0.70). Surprisingly, only 22% of participants with objective irreversible OLD reported a physician diagnosis of chronic bronchitis,COPD or emphysema.

CONCLUSION: We found a high prevalence of undiagnosed OLD among a highly symptomatic inner city population.

CLINICAL IMPLICATIONS: Screening spirometry should be performed in inner city smokers who are 35 years of age or older to promote early detection of OLD.

DISCLOSURE: E. Malone, None.