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Use FEV1 as an early COPD detection tool

Editor's note: Lost month, RCM interviewed the National Lung Health Education Program's (NLHEP) American Association of Respiratory Care (AARC) liaison Gretchen Lawrence, who provided an overview of early-COPD de- tection and how respiratory therapists can lead the way in screening patients. This month, we look at using the FEV^ test as a screening tool and one manager's cutting-edge screening and education program.

Most of the general public has no idea what a "Forced Expiratory Volume, one second" (FEV1) test is or what it determines. But the NLHEP is hoping to change all that. The national organization's goal is to make the numbers as well-known among patients and medical personnel as cholesterol and blood-pressure statistics. NLHEP recommends using FEV1 instead of full spirometry as a testing tool for early detection of the several smoking-related diseases under the umbrella of COPD. This simple subset of full-blown spirometry can be used to quickly test a lot of people in an afternoon at a health fair, yet its clinical track record proves it's an effective tool in detecting lung disease—or at least raising a red flag for patients whose condition warrants more in-depth lung testing.

One manager's approach
In conjunction with NLHEP, Vicky Shrader, BS, RRT, CPFT, launched a program that both teaches local primary care physicians how to do simple spirometry and takes portable equipment to malls, office buildings, and community health fairs to test the public.

"Everybody should know Vicky Shrader, because what she's done is terrific," says Louise Nett, RN, RCP, FAARC, research associate for NLHEP. "We'd like to see programs like that developed all over the country."

It all began when Shrader, director of pulmonary services at Hanover Hospital, and pulmonologist Michael Ader, MD, got together and formed the Hanover Area Coali- tion for Lung Health, an umbrella group that sponsors the testing and local advertising for the cause.

"Ader said, 'I'm sick to death of getting referrals or con- sults from physicians for patients who are being treated for lung disease who have never had a screening, spiro- metry, or never had any kind of breathing test at all,' " Shrader says.

A doctor's visit
Like many public programs spearheaded by therapists, FEV1 testing programs will be more easily sold to ad- ministration by a champion on the medical staff. At Hanover Hospital, Ader filled that role. His involvement added weight to the therapists' message when they approached local physicians about offering FEV1 testing to patients.

"It's tough to get the message to the physician or primary care doctor; they have so much on their plate that they're going to pay more attention if it's coming from someone they respect," says Shrader, whose coalition mailed letters and posters promoting lung health to doctors. "It definitely helps to have someone in your comer who can push it and market it to the physician."

Since 1999 when the coalition started teaching staff at local doctors' offices about simple spirometry, 50% more doctor's offices in the area own spirometry equipment, according to surveys conducted before the program and last year. More doctors offer the test to patients and can competently administer it themselves than ever before.

The test
Administering free simple spirometry isn't easy or quick work, Shrader says, and not everyone needs an FEV1 test. The Hanover therapists who hit the road with spirometers don't turn anyone away, but they try to target likely candidates for COPD—smokers over 45 or anyone with symptoms. About 20 or 30 people can be tested in a four-hour shift, so the more targeted the testing, the more effective the early COPD detection. Since the goal is finding people at risk for COPD, not conducting research, the only information asked of testees is height and age, so staff can compare the numbers they blow to the norm. On the two-part forms, name is optional.

Therapists perform the test several times to ensure they obtain an accurate reading. After recording the results, the tester finishes filling out the form, hands the person being tested a copy, and keeps the second copy for the program's records.

In their public screenings, Hanover therapists have honed their pitch well enough that they are testing more appropriate candidates—of the approximately 1,500 people tested since June of 2000, 32% blew an FEV1 below 80% of the norm, the indicator for potential COPD.

"It's a lot of people who would not have had any indication that they were heading down that path had they not had this screening done," Shrader says. If patients blow a low FEV1, therapists recommend they consult their primary care physicians to further ex- plore their lung-function numbers. They don't offer a diagnosis. All smokers receive information about tobacco cessation, regardless of their FEV1 test results.

Funding? What funding?

NLHEP is an idea bank, not a financial one. The group can offer logos, research reports, and downloads galore, but the cash and equipment to start a public testing program has to come from somewhere else.

At Hanover Hospital, Shrader's coalition acquired some funding and equipment in a creative way—Dr. Ader gave presentations for pharmaceutical companies and businesses in exchange for donations. That helped build up a war chest for advertising expenses and the portable spirometers, which cost about $500 each. Medical-equipment manufacturers donated disposable cardboard mouthpieces for the spirometers.

"We didn't spend a whole lot of money," Shrader says. "This is not something that will break the bank for a small community hospital."

Promotions and advertisements
After convincing administration to back your idea, find- ing a physician to endorse it, and locating a public space, you have to make sure people show up. Advertise your FEV1 testing station through newspaper and radio free community schedule announcements.

Your hospital's Web site and newsletters mailed out to the community are also effective, inexpensive ways to promote spirometry, COPD awareness, and free testing events. Shrader's group purchased billboard advertising with such slogans as "Hey! Emphysema can kill you!"

Recruiting in-kind support from the hospital— including time from the marketing/community relations department to assist in designing ads—helped the coalition most effectively use the few financial resources it had at its disposal.

At the end of the day, Shrader feels that her group's FEV1 testing and awareness program has worked well. "Everybody knows if they have high cholesterol or blood pressure—they know those numbers inside and out," Shrader says. "With FEV1 and lung disease, its been kind of ignored. . . I think we're making an impact here."

Looking for more information on FEV1 screening?

The National Lung Health Education Program's Web site, www.nlhep.org, offers instructional literature on how FEV1 testing works, how to blow into a spirometer, and how to make sense of the numbers. You can distribute this information to the public and local physicians, The site also offers a very detailed account of Shrader's program in a Microsoft PowerPoint presentation that includes the following:

Managers who want more information about starting an FEV1 testing program are welcome to contact Shrader at sbraderv@ hanoverhospital.org. -A-

Page 6 2002 Opus Communications, a division of HCPro Respiratory Care Manager—My 2002
Respiratory Care Manager—July 2002 2002 Opus Communications, a division of HCPro