To the Editor

We agree with the recent article in the Journal by Sippel et al.,¹ which concludes that routine spirometry does not motivate smoking cessation. These results agree with three prior randomized controlled trials.² This is a very important question as the National Heart, Lung, and Blood Institute (NHLBI) has recently considered whether to recommend that our nation screen smokers for obstructive airways disease (OAD) and has also initiated the National Lung Health Education Program.³

Sippel's study advances the case against screening for OAD. In addition, Sippel found a trend that subjects with abnormal spirometry were less likely to quit smoking over the ensuing year. Although long-term trials suggest that abnormal spirometry predicts smoking cessation, prior trials of a year or less duration consistently find smokers with abnormal spirometry are less likely to quit.²

In conclusion, smokers who receive spirometry are not more likely to quit smoking, even if their results are abnormal. As smoking cessation is the only efficacious treatment for asymptomatic OAD, this study adds to evidence against screening. The public health burden of smoking and OAD is large. Our nation should put a tremendous effort into methods to reduce smoking, but not by burdening physicians with the additional responsibility of unjustified screening for asymptomatic OAD.