REPLY
Vital Capacity as a Predictor of Premature Death
David B. Pryor
15 September 1993 | Volume 119 Issue 6 | Pages 538-539
IN RESPONSE:
We appreciate Dr. Petty's interest in and support of our article [1]. Before rushing out to equip every primary care physician's office with a spirometer, however, we would point out the differences between our study and those cited by Dr. Petty.
All our patients reported chest pain thought to require subsequent diagnostic testing. Studies cited by Dr. Petty [2, 3] focused on a healthy, asymptomatic population. The distinction is important for two reasons. First, the independent prognostic value of characteristics in healthy asymptomatic patients may be substantially lower in symptomatic patients after adjusting for known prognostic characteristics. For example, the added prognostic importance of traditional risk factors in coronary disease is small when the patient's symptoms (of angina and congestive heart failure), degree of myocardial damage, anatomy, and ventricular function are considered. Second, as William Stead has said, "It's hard to make an asymptomatic patient feel better." The use of a test should be considered in the context of how it can improve outcome by changing patient management.
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 Chronic Dis. 1985; 38:703-10.
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