A office Spirometer costs about $800. At least one Kitsap County
resident has pledged to donate the machine to the KCHD – Will the
Kitsap County Health District – Finally – Play Early Detection
Spirometry?
WHEN will the Kitsap County Health District (KCHD) get concerned
with early detection Spirometry testing for COPD (Chronic
Obstructive Pulmonary Disease) the 4th leading cause of death in
the country?
120,000 people die each year from COPD …many of them could have
been stopped in its tracks by early detection.
Thanks to Steve Nelson we know Kitsap County has about 9,200
diagnosed COPDers. This slow developing disease takes about twenty
years to develop symptoms enough to tell the doctor. The educated
guess is that another 9,200 or more are undetected. A Spirometry
test could save lives and millions in public funds to medically
treat COPDers and other diseases that may develop after COPD opens
the door.
The KCHD’s stated online Program Goal in part:
“Community Health Promotion carries out the Health District’s
mission by developing and implementing culturally competent
outreach and educational programs and policies to positively
influence health behavior and health choices among Kitsap County
residents.
…
* Community mobilization;
* Coalition development and collaboration with external
partners;
* Health education intervention planning, implementation, and
evaluation;
* Utilization of social marketing strategies;
* Utilizing a strength-based (asset framework).
Community Health Promotion areas of focus include:
* Tobacco Prevention and Control;
* Injury Prevention;
* Kitsap Gets Active;
* Outreach to Hispanic Families;
* Adolescent Health Education;
* Breast and Cervical Health;…”
http://www.kitsapcountyhealth.com/community_health/health_promotion/hp_index.htm
Where is early detection Spirometry testing for COPD?
The KCHD is involved with Breast and Cervical Health when COPD
kills more people per year than Breast and Lung Cancer
combined.
COPD is ignored.
‘Tobacco Prevention and Control’ is listed. 80% of COPDers were
smokers.
KCHD ignores COPD early detection.
Medscape says:
“… Several well-recognized criteria have been established for
the use of medical tests that have been proposed for the early
detection of disease, [30-34] and spirometry for the detection of
COPD in adult cigarette smokers fulfills all of these criteria:
1. The disease, if not detected early, would go on to cause
substantial morbidity or mortality;
2. Treatment is available that is more effective when used at
the early stage before the development of symptoms than when used
after the symptoms develop; and
3. A feasible testing and follow-up strategy is available
that
a. minimizes the false-positive and false-negative rates,
b. is relatively simple and affordable,
c. uses a safe test, and
d. includes an action plan that minimizes potential adverse
effects.
The above criteria are usually applied to screening tests,
defined as medical tests done for individuals who have no symptoms
or signs that suggest the possibility of disease.
Office spirometry is considered to be a part of a clinical
evaluation and does not fall under the definition of a screening
test when performed for patients with respiratory symptoms who are
seen during a clinical encounter (whether or not they have a
history of cigarette smoking). Also, if the patient has been
diagnosed as having tobacco addiction (a disease with a code in the
International Classification of Diseases, ninth revision), office
spirometry may be indicated to assess the severity of that disease
and is not then considered to be a screening test. Although the
NLHEP does not recommend office spirometry for screening unselected
populations or for testing patients who have no cardiopulmonary
risk factors, the next section of this document provides evidence
that office spirometry fulfills all of the criteria listed above
when it is used to detect COPD in adult smokers.
The Disease, If Not Detected Early, Would Go On to Cause
Substantial Morbidity or Mortality
Office Spirometry Is Relatively Simple and Affordable
Spirometry is a relatively simple, noninvasive test. Office
spirometry takes only a few minutes of the patient’s and
technician’s time and includes a few athletic-type breathing
maneuvers of 6 s duration. The economic costs of a spirometry test
include the cost of the instrument and the cost of personnel time
(both training and testing). Diagnostic spirometers currently cost
about $2,000, and about $10 of time per test is spent in testing
(including training time) and disposable supplies. Office
spirometers will cost , $800 and require even less testing time
than diagnostic spirometers. Adding a post-bronchodilator
spirometry test for asthma adds about 15 min to the test time (but
is not needed for COPD evaluations).
COPD is the most important lung disease encountered and the
fourth leading cause of death in the United States, and it affects
at least 16 million people.[7,35] Of the top causes of mortality in
the United States, only the death rate for COPD continues to rise,
increasing by 22% in the past decade. The 10-year mortality rate
for COPD after diagnosis is > 50%.[36] In addition, the number
of patients with COPD has doubled in the last 25 years, with the
prevalence of COPD now rising faster in women than in men.[37]
Although the frequency of hospitalization for many illnesses is
decreasing, the number of hospital discharges for COPD rose in the
last decade. COPD causes 50 million days per year of bed disability
and 14 million days per year of restricted activity.[38,39] COPD
causes about 100,000 deaths per year, 550,000 hospitalizations per
year, 16 million office visits per year, and $13 billion per year
in medical costs, including home care.[35]
Treatment Is Available That Is More Effective When Used at the
Early Stage of COPD, Before the Development of Symptoms, Than When
Used After Symptoms Develop
COPD is a slowly progressive, chronic disease …”
http://www.medscape.com/viewarticle/405948_2
Part 1 More later…. Sharon O’Hara
