GPs should not try to detect mild COPD

More than 40 years ago, Robert Hyatt and Paul Enright at The Mayo Clinic in Minnesota wrote an office spirometry book in which primary care practitioners were encouraged to detect COPD early 1 , and concluded: “Spirometry should be performed for all patients over the age of 40 years who smoke cigarettes [but] we do not advocate mass screening”. More than 10 years ago, Enright wrote an editorial for this journal about the use and abuse of office spirometry, concluding that a normal peak expiratory flow (PEF) rules out clinically important COPD, and for smokers with a low PEF, before prescribing expensive daily inhalers, GPs should refer the patient to a local service for good-quality pre- and post-bronchodilator (BD) spirometry and interpretation 2 . Here, we review studies about detecting mild COPD published since that editorial.