[...] of the 23 executive committee members of the National Lung Health Education Program (the source for the NHLBI recommendation), only one is a family physician, and the preponderance are chest physicians.2 A 2005 systematic review on the use of spirometry for case finding, diagnosis, and management of COPD commissioned by the Agency for Healthcare Research and Quality had different findings.3 The authors found that: (1) clinical improvement was not associated with a patient's spirometric response to therapy; (2) treatments other than smoking cessation did not alter the rate of spirometric decline over time; (3) there was wide intra-individual variation in spirometric decline; and (4) interventions were not effective in asymptomatic persons or those with mild to moderate airflow obstruction. Following the NHLBI guideline, they estimated that 941 patients would need to be screened to reduce one person's COPD exacerbations.3 The authors of the systematic review concluded that the evidence does not support widespread use of spirometry in primary care settings for all adults with persistent respiratory symptoms or those with a history of exposure to pulmonary risk factors for case finding, improving smoking cessation rates, monitoring the clinical course of COPD, or adjusting COPD interventions; that routine spirometric testing in primary care settings is likely to result in considerable testing and treatment costs, resource use, and health care personnel time; and that it is likely to label a large number of persons (many not reporting bothersome respiratory symptoms or having nondisabling symptoms) as diseased who would not benefit from testing or treatment.3 The American College of Physicians' guideline on the diagnosis and management of stable COPD is consistent with this evidence.4 Although American Family Physician articles routinely include a SORT ratings table, readers' understanding of the ratings is important for appropriate translation into practice.
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