Ever Smoking is Not Associated with Performed Spirometry while Occupational Exposure and Respiratory Symptoms are

Abstract

Objective

Despite recommendations, assessment using spirometry or peak expiratory flow is insufficient in the clinical evaluation of suspected obstructive pulmonary disease. The aim was to investigate factors associated with performing spirometry or peak flow expiratory flow assessment.

Methods

Randomly selected subjects from the general population aged 50–65 completed a respiratory questionnaire with items about the history of previously performed spirometry or peak expiratory flow. The association between ever having had spirometry or peak expiratory flow performed was analyzed for smoking, age, sex, occupational exposures, dyspnea, wheeze, self-reported physician diagnosed asthma and COPD using multivariable logistic regression models. The results are presented as odds ratios (OR) with 95% confidence intervals (95% CIs).

Results

Of the 1105 participants, 43.4% (n=479) had a history of previously performed spirometry or peak expiratory flow. Occupational exposure (OR 1.72, [95% CI] 1.30–2.27), wheeze (OR 2.29, 1.41–3.70), and dyspnea (OR 1.70, 1.11–2.60) were associated with previously performed spirometry. Compared to men, women had spirometry or peak expiratory flow performed less often (OR 0.67, 0.51–0.86). Neither current smoking (OR 0.83, 0.57–1.20) or former smoking (OR 1.27, 0.96–1.67) were associated with performed spirometry or peak expiratory flow.

Conclusion

We found no relation between smoking status and a history of previously performed spirometry or peak expiratory flow in a population-based sample of middle-aged people. This is surprising regarding the strong guidelines which highlight the importance for spirometry surveillance on current smokers due to their increased risk of lung disease. Male sex, respiratory symptoms and occupational exposures to air pollution were associated with previously performed spirometry or peak expiratory flow. The association with occupational exposure may be an effect of pre-employment screening and workplace surveillance, and the findings indicate that females do not receive the same attention regarding spirometry or peak expiratory flow.

Keywords:

• lung function test
• spirometry and PEF
• smoking
• occupational exposure
• respiratory symptoms
• SCAPIS pilot

Ethical Approval

The study was approved by the Regional Committee of Ethics in Umeå (2010/228-31, 2017/14-31) and by the Swedish Ethical Review Authority (2022-04272-02). All included subjects gave their written consent to participate in the study. Our study complies with the Declaration of Helsinki, and all participants were informed about the purpose of the study.

Acknowledgments

The study was supported by the Swedish Heart and Lung Foundation, the Knut and Alice Wallenberg Foundation, the Swedish Research Council (VR), VINNOVA and the Swedish Council for Working Life, Health, and Welfare (FORTE), the Sahlgrenska Academy at the University of Gothenburg, and strategic grants from ALF/LUA in Western Sweden.

Disclosure

The authors report no conflicts of interest in relation to this work.