November 17 is World COPD Day, when we’re encouraged to visit our doctors for a spirometry test.
As I’ve mentioned before, I have serious problems with this. I don’t know about anyone else, but my COPD tends to fluctuate more or less randomly. Some days, like today, I’m wheezy but otherwise breathing quite well**. On other days I’m breathless just sitting here typing. It varies throughout the day, too. (NB: since typing that maybe an hour ago*** my breathing has deteriorated dramatically, and I am breathless just typing).
**That’s quite well for me – desperately poorly for a normal person.
***No, I don’t type that slowly, I’ve been online tracking down the link in the penultimate para, and replying to emails, as well as taking my meds and supplements.
On that basis I feel that an annual snapshot, via usually poorly-administered spirometry, is worse than useless.
I can monitor my own Peak Flow and Fev1 daily and provide the figures to my GP, if required, which will be of much greater value.
In addition, based on a lifetime’s experience, GP-administered spirometry differs significantly from that in hospitals. Invariably, when tested in hospital, I’ve been tested once, administered a dose of Ventolin, and re-tested 20 minutes later. This measures the degree of reversibility of the airways obstruction, which diminishes as COPD worsens. And the test has always been “best of three”.
At the GP, it’s just one blow and you’re done (it used to be best of three – not any more).
So what’s the point? Only one, as far as I can see – the practice gets paid for this pointless testing. But I, as you’ll see, get wrongly pigeonholed.
There is absolutely no benefit to the patient and, as my meds are scheduled so that I function best around midday, testing always falls during my daily “sweet spot”. Not, say, early in the morning or, more importantly, late at night, when breathing can be a challenge. And often, having blown into the device to the max, it can be very hard to actually breath in again. Is any heed paid to this at all? No, it’s bloody not.
And on the hyper-simplistic “traffic-light” rating, I always get a higher score than would be justified were this test repeated at several points throughout the day.
Based on my symptomology and medication, I have Stage 4 COPD (very severe – see this document based on GOLD), but on the idiot traffic-light system, once-a-year snapshot, I’m barely moderate. And that’s dangerous.
There’s something else to consider, too. I read, some years ago, that as people with chronic respiratory illness age, Peak Flow becomes increasingly unreliable, giving false highs due to the major airways becoming fixed and dilated.
GOLD rightly ignores Peak Flow, and focuses on FEV-1 (Forced Expiratory Volume in one second), and FVC (Forced Vital Capacity – the blow til you turn purple test!), among much else – see this document.
Hopefully, then, this situation might change, with NICE’s advice to GP’s to use the GOLD guidelines in assessing COPD, as I mentioned yesterday.