| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Division of Infection and Immunity, School of Clinical Sciences, University of Liverpool, 2 Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.
CORRESPONDENCE: P. P. Walker, Clinical Science Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK. Fax: 44 1515295886. E-mail: ppwalker{at}liverpool.ac.uk
Keywords: Bronchodilation, chronic obstructive pulmonary disease, primary care, spirometry
Received: February 8, 2006
Accepted July 11, 2006
Primary-care spirometry has been promoted as a method of facilitating accurate diagnosis of chronic obstructive pulmonary disease (COPD). The present study examined whether improving rates of diagnosis lead to improvements in pharmacological and nonpharmacological management.
From 1999 to 2003, the current authors provided an open-access spirometry and reversibility service to a local primary-care area, to which 1,508 subjects were referred. A total of 797 (53%) had pre-bronchodilator airflow obstruction (AFO). Of the subjects who underwent reversibility testing, 19.3% were no longer obstructed post-bronchodilator. The results and records of a subgroup of 235 subjects with post-bronchodilator AFO were examined.
Of the 235 subjects, 130 received a new diagnosis, most commonly COPD. The patients with COPD were significantly undertreated before spirometry and testing led to a significant increase in the use of anticholinergics (37 versus 18%), long-acting ß-agonists (25 versus 8%) and inhaled steroids (71 versus 52%). More than three quarters of smokers received smoking cessation advice but very few were referred for pulmonary rehabilitation.
In conclusion, primary-care spirometry not only increases rates of chronic obstructive pulmonary disease diagnosis, but it also leads to improvements in chronic obstructive pulmonary disease treatment. The use of bronchodilator reversibility testing in this setting may be important to avoid misdiagnosis.
This article has been cited by other articles:
|
|
 |
|
  P. Enright Provide GPs with spirometry, not spirometers Thorax, May 1, 2008; 63(5): 387 - 388. [Full Text] [PDF]
|
|
|
|
|
|
J A Walters, E C Hansen, D P Johns, E L Blizzard, E H Walters, and R Wood-Baker A mixed methods study to compare models of spirometry delivery in primary care for patients at risk of COPD Thorax, May 1, 2008; 63(5): 408 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Lucas, F. Smeenk, I. Smeele, and C. van Schayck Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study Fam. Pract., April 1, 2008; 25(2): 86 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Calverley Fulfilling the promise of primary care spirometry Eur. Respir. J., January 1, 2008; 31(1): 8 - 10. [Full Text] [PDF]
|
|
|
|
|
|
E. Derom, C. van Weel, G. Liistro, J. Buffels, T. Schermer, E. Lammers, E. Wouters, and M. Decramer Primary care spirometry Eur. Respir. J., January 1, 2008; 31(1): 197 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. P. Poels, T. R. J. Schermer, D. P. A. Schellekens, R. P. Akkermans, P. F. de Vries Robbe, A. Kaplan, B. J. A. M. Bottema, and C. van Weel Impact of a spirometry expert system on general practitioners' decision making Eur. Respir. J., January 1, 2008; 31(1): 84 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Young, R. Hopkins, and T. E. Eaton Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes Eur. Respir. J., October 1, 2007; 30(4): 616 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. P. Yawn, P. L. Enright, R. F. Lemanske Jr, E. Israel, W. Pace, P. Wollan, and H. Boushey Spirometry Can Be Done in Family Physicians' Offices and Alters Clinical Decisions in Management of Asthma and COPD Chest, October 1, 2007; 132(4): 1162 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. P. Poels, D. P. A. Schellekens, and T. R. Schermer Effect of spirometry on COPD management in primary care: where are the studies that we really need? Eur. Respir. J., April 1, 2007; 29(4): 820 - 820. [Full Text] [PDF]
|
|
|
|
|
|
P. P. Walker and L. Davies From the authors Eur. Respir. J., April 1, 2007; 29(4): 821 - 821. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
