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Copyright ©ERS Journals Ltd 2008
Primary care spirometry*
1 Dept of Respiratory Diseases, Ghent University Hospital, Ghent, 3 Pneumology Unit, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, 4 Dept of General Practice, and 7 Respiratory Rehabilitation and Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium. 2 Dept of General Practice, Radboud University Medical Centre, Nijmegen, 5 Gelre Hospital, Location Het Spittaal, Zutphen, and 6 Dept of Respiratory Medicine, Maastricht University, Maastricht, The Netherlands.
CORRESPONDENCE: E. Derom, Dept of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Fax: 32 93322341. E-mail: eric.derom{at}Ugent.be
Keywords: Airways obstruction, American Thoracic Society/European Respiratory Society criteria, chronic obstructive pulmonary disease, flow–volume loop, forced expiratory volume in one second, pulmonary function
Received: June 2, 2007
Accepted October 2, 2007
Primary care spirometry is a uniquely valuable tool in the evaluation of patients with respiratory symptoms, allowing the general practitioner to diagnose or exclude chronic obstructive pulmonary disease (COPD), sometimes to confirm asthma, to determine the efficacy of asthma treatment and to correctly stage patients with COPD. The use of spirometry for case finding in asymptomatic COPD patients might become an option, once early intervention studies have shown it to be beneficial in these patients.
The diagnosis of airway obstruction requires accurate and reproducible spirometric measurements, which should comply with the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. Low acceptability of spirometric manoeuvres has been reported in primary care practices. This may hamper the validity of the results and affect clinical decision making. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometric results in clinical practice and enhance the quality of interpretation.
Softening the stringent ATS/ERS criteria could enhance the acceptability rates of spirometry when used in a general practice. However, the implications of potential simplifications on the quality of the data and clinical decision making remain to be investigated.
Hand-held office spirometers have been developed in recent years, with a global quality and user-friendliness that makes them acceptable for use in general practices. The precision of the forced vital capacity measurements could be improved in some of the available models.
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