Association of Timely Spirometry With Lower All-Cause Mortality: A Nationwide Obstructive Cohort Study.

Area of Science:

• Pulmonology
• Public Health
• Clinical Diagnostics

Background:

• Spirometry is the gold standard for diagnosing Chronic Obstructive Pulmonary Disease (COPD).
• Despite its importance, spirometry is underutilized in routine clinical practice.
• This study investigates factors influencing timely spirometry use and its impact on patient outcomes.

Purpose of the Study:

• To identify factors associated with timely spirometry at the initiation of chronic respiratory treatment.
• To determine if spirometry is linked to a reduced risk of mortality.
• To analyze factors contributing to delays in spirometry testing.

Main Methods:

• Analysis of nationwide Belgian data for adult users of chronic respiratory medication.
• Multivariable logistic regression to examine odds of timely spirometry.
• Multivariable Cox regression and Fine-Gray subdistribution hazard regression for survival and delay analyses.

Main Results:

• Only 20.9% of chronic treatment initiators had spirometry at initiation; 13.8% during follow-up.
• Timely spirometry was associated with a 34% lower mortality risk.
• General practitioners performed only 5.1% of spirometry tests, despite prescribing most treatments.
• Factors like smoking and comorbidities increased spirometry likelihood; female sex, younger/older age, cognitive impairment, and frailty decreased it.

Conclusions:

• Spirometry is significantly underused, particularly in primary care settings.
• Vulnerable populations, including never-smoking females, face higher risks of underdiagnosis and suboptimal care.
• Initiating spirometry at treatment start is linked to better patient prognosis, likely due to more personalized care.