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Office spirometry is 30 years old, but is not mature.

The study by Kaminsky et al1 published in this issue suggests that, despite 3 decades of growth, spirometry done in the offices of primary care practitioners has not yet matured. A first-generation office spirometer was the Breon 2400, designed by a pharmaceutical company in the early 1970s and popularized by our innovative and evangelistic mentor, Thomas L Petty.2 Available now for as little as $25 at Ebay.com, the little blue Breon 2400 remains a robust and accurate instrument for detecting airway obstruction, using the ratio of forced expiratory volume in the first second (FEV1) to FEV6, and for following treatment responses with FEV1 changes. Medicare reimburses about $65 for a spirometry test, which takes less than 5 min to perform. Yet the majority of primary care practitioners don’t own a spirometer, and of those who do have one, fewer than 5 tests per month are done (none of which includes post-bronchodilator responsiveness). So why has office spirometry not matured to become a routinely performed test for almost all patients with respiratory symptoms and risk factors, as recommended by several professional societies?3