Primary Care Respiratory Journal (2010); 19(2): 91-92 EDITORIAL Check the FEV1 for all adult smokers, even

patients without respiratory symptoms Clinical practice guidelines (CPGs) usually become more complicated over time, but new evidence – including a study published in this issue of the PCRJ1 – makes COPD case-finding easier and much more efficient. The forced expiratory volume in one second (FEV1) should be measured using an inexpensive pocket spirometer for all smokers aged 40 and over, regardless of the presence or absence of respiratory symptoms. Only the one patient in eight with a low FEV1 then needs pre- and post-bronchodilator spirometry to confirm clinically-important COPD. More than 30,000 spirometry tests were done by 440 Swiss GPs for their currently-smoking patients,2 as recommended by many CPGs. Of those with good quality spirometry and short respiratory questionnaires, about 13 % had clinically-important COPD for which inhaler treatment might be considered (a low FEV1/forced vital capacity (FVC) ratio, and FEV1 below 65 % predicted), but these patients were no more likely than the others to report cough, phlegm, wheeze, or dyspnoea.1 As confirmed by other investigators,3 the COPD screening questionnaires developed and advertised by drug manufacturers4-6 provided n