CHEST Guidelines-Increasing-Divergence-in-Spirometry-Recommendation

Increasing-Divergence-in-Spirometry-Recommendation
Pdf Summary
The commentary by Graham et al. discusses the issue of divergent spirometry interpretation guidelines for diagnosing Chronic Obstructive Pulmonary Disease (COPD) and the necessity of reaching consensus among organizations like the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the American Thoracic Society (ATS), and the European Respiratory Society (ERS). Spirometry is crucial for diagnosing obstructive lung diseases, but disagreements in interpretation protocols can lead to misdiagnosis and inappropriate treatments.<br /><br />The GOLD 2023 report and ATS/ERS guidelines provide differing recommendations, such as the use of a fixed FEV1/FVC ratio of less than 0.70 for COPD diagnosis, which may lead to overdiagnosis in older adults and underdiagnosis in younger populations. In contrast, ATS/ERS recommends the use of z-scores that adjust for age, sex, and height to provide a more nuanced understanding, reducing such biases.<br /><br />GOLD's suggestion to follow older 2005 spirometry standards rather than the updated 2019 standards by ATS/ERS introduces variability, as it advocates differing repeatability tolerances and methods for calculating FEV1/FVC ratios. Such inconsistencies can create significant variances in clinical interpretations and patient outcomes.<br /><br />The authors stress the requirement for more aligned and convergent guidelines to ensure accurate diagnosis and management of COPD. Using z-scores rather than fixed thresholds could enhance diagnostic sensitivity and accuracy. Additionally, incorporating patient history and risk factors into spirometric interpretations is vital.<br /><br />Finally, the integration of technological advances and artificial intelligence in spirometry could enhance testing quality and interpretation in primary care, but achieving this requires consistent, standardized guidelines across institutions. The push for harmonization is crucial to minimize confusion and improve lung health outcomes.
Keywords
COPD
spirometry
GOLD
ATS
ERS
FEV1/FVC
z-scores
diagnosis
guidelines
artificial intelligence