Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD

Harvard University, Cambridge, Massachusetts, United States
Chest (Impact Factor: 7.13). 10/2007; 132(4):1162-8. DOI: 10.1378/chest.06-2722
Source: PubMed

ABSTRACT Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care.
To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry.
A before-and-after quasiexperimental design.
Three hundred eighty-two patients from 12 family medicine practices across the United States.
Patients with asthma and COPD, and staff from the 12 practices.
Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing.
Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD.
US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.

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    • "The main reason for disagreement on diagnosis was that COPD was not diagnosed by GPs, while according to international criteria the test results indicated COPD. A study of Yawn et al. likewise found disagreements between GPs and pulmonologists on the interpretation of spirometry results in 88 out of 368 tests (24%) [10]. Most common reasons for disagreement in this study were overreporting of airflow obstruction in patients with normal spirometry results by GPs, interpreting restrictive patterns in people with poor effort and diagnosing COPD in absence of spirometry results indicating COPD. "
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    • "For those with recognized COPD, current management is frequently incompatible with recommended care (ATS 2004; GOLD 2007; NICE 2007) For those who have unrecognized COPD, opportunities to improve their functional status, quality of life, and prevention of exacerbations are missed by failure to recognize the disease (Pena et al 2000; Halbert et al 2003, 2006; Zaas et al 2004; Lindberg et al 2006). Among the barriers that may slow the implementation of evidence-based COPD management are ambiguous and divergent US recommendations for COPD screening (NLHEP 1998; Hardie et al 2002; Bolton et al 2005; Wilt et al 2005; Hansen-Flaschen 2007; Yawn et al 2007). The lack of well recognized US primary care guidelines for the management of diagnosed COPD is another potential barrier to an aggressive primary care approach to COPD. "
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