Lung Health Study: Pulmonary Function Testing
It is well known to the readers of the American Review of Respiratory Diseasesthat chronic obstructive pulmonary disease (COPD) is a significant health problem in the United States. For the pulmonary community, therefore, COPD research remains a priority as we strive to determine more effective methods for early detection, treatment, and prevention. Although it is well recognized that cigarette smoking is the single most important cause of this disease, many of our citizens continue to smoke. The Federal Government remains active in its support of programs designed to investigate the pathogenesis of COPD, while at the same time encouraging research on methods for early detection of disease as well as new approaches to cigarette smoking cessation as a means of disease prevention. At the National Heart, Lung, and Blood Institute (NHLBI), while we watch the increases In mortality from COPD, we also watch with envy the impressive declines in heart disease mortality. We know that the declines in mortality from coronary heart disease have come as a result of decades of epidemiologic investigations that have developed the science base for programs on prevention of heart disease. The importance of high blood pressure and increased blood cholesterol as risk factors for coronary heart disease was appreciated only after data were available from extensive clinical and pathological research investigations, as wellas numerous long-term epidemiologic studies. The risks for cardiovascular disease posed by elevated blood pressure and high blood cholesterol levelsare now well known to the public. Control of these two risk factors is thought to be the reason for the decline in coronary heart disease that is seen in the U.S. population. This achievement took a concerted effort and the backing of the heart community. For example, it took many years to develop accurate and standardized methods
AM REV RESPIR DIS 1991; 143:1211
to measure blood pressure and blood cholesterol. The cardiovascular community formed a network of programs to train technicians to perform blood pressure .measurements in order to assure quality control among laboratories participating in multicenter investigations. Ongoing quality control measures, which weredeveloped by the investigators, were widely backed and supported by the cardiovascular community. Likewise, special sessions on blood cholesterol measurements have been conducted throughout the country; guidelinesfor cholesterol measurements have been developed and tested through the NHLBI Cholesterol Education Program. The heart community has rallied' behind these efforts, thus making it possible to translate results from years of basic research and population based investigations into an impact on public health. The fact that basic and clinical research can impact on public health has clearly drawn the attention of the Congress. Each year, during the appropriations hearings, congressional leaders pay tribute to the heart community for its success, while at the same time providing additional support to the research programs of the NHLBI to continue its wide spectrum of research. The work that is supported through the Lung Health Study is a beginning effort to attempt to use pulmonary function testing to distinguish individuals with early signs of COPD from the general public. Whatever the outcome of the interventions that are part of the Lung Health Study protocol, wealready know that success can be achieved in measuring pulmonary function in a network of laboratories. This is nicely documented in the report in this volume by Enright and colleagues (1). The work of the ten clinical centers participating in the Lung Health Study should be considered just the beginning. There is much to do to before pulmonary function testing gains the momentum of
the blood pressure measurement as a tool for early detection of disease. Data to support this effort should be available through the Lung Health Study, although we certainly recognize that the tests of pulmonary function conducted by the Lung Health Study investigators, designed for scientific investigations, are more complex and detailed than would be required for general use. However, momentum for utilization of results from the Lung Health Study on a wider basis will require the backing of the pulmonary community. Population-based investigations are expensive; they involveyears of effort and commitment by the scientists and support staff as well as the many men and women who volunteer to participate in these investigations. Although the results are certain to provide information that will impact on patient care, we believe they will benefit the research scientist as well. The public and the Congress need to see the results of basic research translated into public health measures. As more information becomes available from basic pulmonary research, the community needs to rally behind an effort to support both clinical and epidemiologic investigations as wellas the demonstration and health education research that is required to test and evaluate the transfer of research to effective utilization by health care providers. It is our hope.that the Lung Health Study will provide an important momentum toward this effort. SUZANNE
S. HURD, PH.D.
Director; Division of Lung Diseases National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD Reference 1. Enright PL, Johnson LR, Connett JE, Voelker H, Buist AS. Spirometry in the lung health study. Am Rev Respir Dis 1991; 143:1215-23.
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It is well known to the readers of the American Review of Respiratory Diseasesthat chronic obstructive pulmonary disease (COPD) is a significant health problem in the United States. For the pulmonary community, therefore, COPD research remains a priority as we strive to determine more effective methods for early detection, treatment, and prevention. Although it is well recognized that cigarette smoking is the single most important cause of this disease, many of our citizens continue to smoke. The Federal Government remains active in its support of programs designed to investigate the pathogenesis of COPD, while at the same time encouraging research on methods for early detection of disease as well as new approaches to cigarette smoking cessation as a means of disease prevention. At the National Heart, Lung, and Blood Institute (NHLBI), while we watch the increases In mortality from COPD, we also watch with envy the impressive declines in heart disease mortality. We know that the declines in mortality from coronary heart disease have come as a result of decades of epidemiologic investigations that have developed the science base for programs on prevention of heart disease. The importance of high blood pressure and increased blood cholesterol as risk factors for coronary heart disease was appreciated only after data were available from extensive clinical and pathological research investigations, as wellas numerous long-term epidemiologic studies. The risks for cardiovascular disease posed by elevated blood pressure and high blood cholesterol levelsare now well known to the public. Control of these two risk factors is thought to be the reason for the decline in coronary heart disease that is seen in the U.S. population. This achievement took a concerted effort and the backing of the heart community. For example, it took many years to develop accurate and standardized methods
AM REV RESPIR DIS 1991; 143:1211
to measure blood pressure and blood cholesterol. The cardiovascular community formed a network of programs to train technicians to perform blood pressure .measurements in order to assure quality control among laboratories participating in multicenter investigations. Ongoing quality control measures, which weredeveloped by the investigators, were widely backed and supported by the cardiovascular community. Likewise, special sessions on blood cholesterol measurements have been conducted throughout the country; guidelinesfor cholesterol measurements have been developed and tested through the NHLBI Cholesterol Education Program. The heart community has rallied' behind these efforts, thus making it possible to translate results from years of basic research and population based investigations into an impact on public health. The fact that basic and clinical research can impact on public health has clearly drawn the attention of the Congress. Each year, during the appropriations hearings, congressional leaders pay tribute to the heart community for its success, while at the same time providing additional support to the research programs of the NHLBI to continue its wide spectrum of research. The work that is supported through the Lung Health Study is a beginning effort to attempt to use pulmonary function testing to distinguish individuals with early signs of COPD from the general public. Whatever the outcome of the interventions that are part of the Lung Health Study protocol, wealready know that success can be achieved in measuring pulmonary function in a network of laboratories. This is nicely documented in the report in this volume by Enright and colleagues (1). The work of the ten clinical centers participating in the Lung Health Study should be considered just the beginning. There is much to do to before pulmonary function testing gains the momentum of
the blood pressure measurement as a tool for early detection of disease. Data to support this effort should be available through the Lung Health Study, although we certainly recognize that the tests of pulmonary function conducted by the Lung Health Study investigators, designed for scientific investigations, are more complex and detailed than would be required for general use. However, momentum for utilization of results from the Lung Health Study on a wider basis will require the backing of the pulmonary community. Population-based investigations are expensive; they involveyears of effort and commitment by the scientists and support staff as well as the many men and women who volunteer to participate in these investigations. Although the results are certain to provide information that will impact on patient care, we believe they will benefit the research scientist as well. The public and the Congress need to see the results of basic research translated into public health measures. As more information becomes available from basic pulmonary research, the community needs to rally behind an effort to support both clinical and epidemiologic investigations as wellas the demonstration and health education research that is required to test and evaluate the transfer of research to effective utilization by health care providers. It is our hope.that the Lung Health Study will provide an important momentum toward this effort. SUZANNE
S. HURD, PH.D.
Director; Division of Lung Diseases National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD Reference 1. Enright PL, Johnson LR, Connett JE, Voelker H, Buist AS. Spirometry in the lung health study. Am Rev Respir Dis 1991; 143:1215-23.
1211
