To the Editor:

We would like to thank the authors Filio Kotrogianni, Foteini Malli, and Konstantinos I Gourgoulianis for their interest in our article, which honors us and encourages us to continue to pursue this line of research. A disease as serious as COPD, which is still considered to be of secondary importance in some parts of the world, should not be neglected.

In their letter, we have noted that the problem of the underutilization of spirometry also happens in their country, which supports our assertion that this does not occur only in developing countries.

It is of note that most of the smokers studied in their report had respiratory symptoms, and most of those with abnormal spirometry results were symptomatic from a respiratory standpoint. This reinforces the concept of active surveillance, suggested by the Global Initiative for Chronic Obstructive Lung Disease, in 2013, rather than spirometry screening for COPD.

In Brazil, most patients first seek medical attention at primary health care facilities, which, consequently, should be prepared to prevent, diagnose, and treat the most common and relevant diseases in the community. Our study and the letter from our colleagues in Greece reveal the need to improve the early detection and diagnosis of COPD, which would reduce its impact and severity. In addition, they alert us to the need for health education for smokers and patients with COPD, so that they understand the nature of their disease, the risk factors for disease progression, their role in fighting the disease, and the role played by health care professionals. Such information can assist health care managers in optimizing the training of primary health care workers regarding the diagnosis of COPD and to increase the availability of diagnostic spirometry.

Considering the prospect of an increase in the prevalence of COPD worldwide, studies such as ours demonstrate the need for action in the context of primary health care in order to increase the awareness of clinicians regarding their responsibility in the initial clinical diagnosis. Despite being inexpensive, diagnostic spirometry is available at few health care facilities, making it difficult to make a definitive diagnosis of COPD in Brazil. The use of spirometry should therefore be expanded.

 
Maria Conceição de Castro Antonelli Monteiro de Queiroz

Attending Physician, Pulmonology Department, Federal University of Goiás School of Medicine Hospital das Clínicas, Goiânia, Brazil



Maria Auxiliadora Carmo Moreira

Associate Professor, Federal University of Goiás School of Medicine,

Goiânia, Brazil



Marcelo Fouad Rabahi

Adjunct Professor, Federal University of Goiás School of Medicine,

Goiânia, Brazil