Chest
Volume 121, Issue 5, Supplement, May 2002, Pages 219S-223S
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John Hutchinson's Mysterious Machine Revisited

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John Hutchinson, a surgeon, recognized that the volume of air that can be exhaled from fully inflated lungs is a powerful indicator of longevity. He invented the spirometer to measure what he called the vital capacity, ie, the capacity to live. Much later, the concept of the timed vital capacity, which became known as the FEV1, was added. Together, these two numbers, vital capacity and FEV1, are useful in identifying patients at risk of many diseases, including COPD, lung cancer, heart attack, stroke, and all-cause mortality. This article cites some of the rich history of the development of spirometry, and explores some of the barriers to the widespread application of simple spirometry in the offices of primary care physicians.

Section snippets

Vital Capacity as a Predictor of Heart Disease

In 1980, the Framingham Study of 5,209 men over the age of 30 years reported that the vital capacity was a powerful prognostic indicator6:

This simple office procedure is a useful predictor of pulmonary disease and cardiac failure and can effectively select groups of persons destined for premature death. Since the FVC predicts cardiovascular as well as noncardiovascular mortality this pulmonary function measurement seems truly a measure of living capacity useful for insurance and underwriting

Barriers to Widespread Applications

If the vital capacity is so important to clinical medicine, why don't all physicians have spirometers in their offices just as they have the chest radiograph (introduced into medicine in 1895), the sphygmomanometer (invented in 1896), or an ECG machine (invented in 1903)? Could it be that pulmonologists and physiologists who established pulmonary function laboratories clouded their instrument in mystery, so as to obscure the true value of spirometry in primary care medicine? If so, “we have

The Essence of Spirometry

Spirometry is a simple expression of a complex process, just like BP. When the lungs are filled, they and the thorax are stretched to the maximum. Following a forced expiration, the lungs empty down to the residual volume, leaving a small amount of air in the upper portions of the lung, (Fig 4). This is because the upper lung has less elastic recoil than the lower part of the lung. The spirogram reflects the muscular effort to start the process, elastic recoil of lungs and thorax, small airways

Foundations for COPD Screening

The third National Health and Nutrition Examination Survey, which looked at a random population of > 20,000 Americans, shows a high prevalence of undiagnosed and untreated COPD, which increases with age. This study of a large random sample of the US population reveals a high prevalence of COPD in both current and former smokers that was not diagnosed, even in the face of clinical respiratory symptoms of classic cough and dyspnea.21 An earlier study of smokers with only mild airflow obstruction,

Popularity of the Sphygmomanometer

Contrast the history of spirometry with that of the development and widespread application of the sphygmomanometer, invented 50 years after the spirometer. The cuff sphygmomanometer was invented by Italian physician Scipione Riva-Rocci in 1896. This simple device caught the eye of US surgeon Harvey Cushing, who believed he could use it in the measurement of BP, which would be useful in his ongoing studies of cerebral perfusion. Cushing introduced this instrument at Johns Hopkins Hospital. Early

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