TO THE EDITOR:
Pryor and colleagues' article [1] should interest all primary care physicians who want to pursue a cost-effective approach to the diagnosis and treatment of coronary artery disease. Their study, however, ignores one of the best indicators of premature morbidity and mortality from heart disease, namely, vital capacity obtained from simple spirometry [2]. Indeed, all excess mortality can be predicted by spirometric measurements [3]. First introduced to medicine in 1846 by the surgeon John Hutchinson [4], the spirometer may be as useful in the office of all primary care physicians as electrocardiographic machines in identifying patients at risk for premature coronary artery disease. It is also useful for predicting premature morbidity and mortality from lung disease [5].
1. Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE Jr, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993; 118:81-90.
2. Kannel WB, Lew EA, Hubert HB, Castelli WP. The value of measuring vital capacity for prognostic purposes. Trans Assoc Life Insur Med Dir Am. 1980; 64:66-83.
3. Beaty TH, Newill CA, Cohen BH, Tockman MS, Bryant SH, Spurgeon HA. Effects of pulmonary function on mortality. J Chron Dis. 1985; 38:703-10.
4. Hutchinson J. On the capacity of the lungs and on the respiratory function with a view of establishing a precise and easy method of detecting disease by the spirometer. Trans Med Cir Suc (London). 1846; 29:137-252.
5. Sorlie P, Lakotos E, Kannel WB, et al. Influence of cigarette smoking in lung function at baseline and at follow up in 14 years. The Framingham Study. J Chronic Dis. 1987; 40:819-53.
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