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David M. Mannino, MD; Ruth A. Etzel, MD; W. Dana Flanders, MD

Arch Intern Med. 1993;153(16):1892-1897.

Abstract
Background
We sought to determine whether an abnormal respiratory history or chest physical examination could be used to identify men with low lung function.

Methods
We analyzed pulmonary function, physical examination, and questionnaire data from 4461 middle-aged male Vietnam-era army veterans.

Main Results
The study sample consisted of 1161 never smokers, 1292 former smokers, and 2008 current smokers. Clinical indicators of respiratory disease (respiratory symptoms, respiratory signs, or a history of respiratory disease), were present in 26.1% of the never smokers, 31.7% of the former smokers, and 47.2% of the current smokers. We defined low forced expiratory volume in 1 second as a value less than 81.2% of the predicted value. Seven percent of the never smokers, 8% of the former smokers, and 17.3% of the current smokers demonstrated low forced expiratory volume in 1 second. Among those with a clinical indicator for spirometry only 11% of the never smokers, 13% of the former smokers, and 21% of the current smokers actually had a low forced expiratory volume in 1 second. Among those without a clinical indicator 6% of the never smokers, 6% of the former smokers, and 14% of the current smokers actually had a low forced expiratory volume in 1 second.

Conclusions
The use of clinical indicators as a basis for obtaining pulmonary function tests in middle-aged men misses many with low lung function, especially current smokers.

(Arch Intern Med. 1993;153:1892-1897)

Author Affiliations
From the National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga.

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