ERJ
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Permissions
Right arrowRequest Permissions
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chavannes, N. H.
Right arrow Articles by Schermer, T. R. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chavannes, N. H.
Right arrow Articles by Schermer, T. R. J.
Eur Respir J 2006; 28:1067
Copyright ©ERS Journals Ltd 2006

Prejudgement towards the quality of spirometry in primary care does not help our case

N. H. Chavannes1 and T. R. J. Schermer2

1 Health Center Zuiderkroon, Rotterdam and Dept of General Practice, Maastricht University, Maastricht, and 2 Dept of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

To the Editors:

We very much appreciate the contribution by Zielinski et al. 1 on the topic of early detection of chronic obstructive pulmonary disease (COPD) by high-risk population screening in the April issue of the European Respiratory Journal. The authors mention that "insufficient quality of spirometries performed in the primary care setting was also reported recently by Schermer et al." We were quite surprised to notice that in referring to our paper on the validity of spirometry in general practice 2, Zielinski et al. 1 fail to appreciate the observation that the 61 primary-care practices involved in our study actually achieved comparable, or even slightly higher, forced expiratory volume in one second and forced vital capacity values and produced an identical proportion of reproducible tests as the four hospital-based pulmonary function laboratories involved. In contrast to our findings, the study reported recently by Enright et al. 3 clearly demonstrates that the performance rate of technicians in a pulmonary function laboratory can indeed be very high. However, significant variation in spirometry test results between laboratories has previously been reported by Dowson et al. 4. This should be kept in mind when judging the quality of spirometry in primary-care settings.

In addition, we have previously shown that trained primary-care physicians are able to recognise obstructive flow patterns correctly in >90% of cases 5. Sufficient quality of basic spirometry tests and recognition of subjects with undiagnosed COPD can thus be performed in the primary-care setting, provided that personnel is adequately trained and regular feedback on performance is available. When touching upon the important issue of raising COPD awareness, one ought to consider mobilising the vast potential of primary healthcare professionals, who deliver essential care to the majority of patients with chronic respiratory disease worldwide.

The suboptimal accuracy of primary-care spirometry may come at the cost of an inevitable but small number of false-positive cases. Still, when one pursues to reach the large pool of as yet undiagnosed subjects with chronic obstructive pulmonary disease in the population, the involvement of primary care professionals is indispensable.

REFERENCES

  1. Zielinski J, Bednarek M, Gorecka D, et al. Increasing COPD awareness. Eur Respir J 2006;27:833–852.[Free Full Text]
  2. Schermer TR, Jacobs JE, Chavannes NH, et al. Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease (COPD). Thorax 2003;58:861–866.[Abstract/Free Full Text]
  3. Enright PL, Beck KC, Sherrill DL. Repeatability of spirometry in 18,000 adult patients. Am J Respir Crit Care Med 2004;169:235–238.[Abstract/Free Full Text]
  4. Dowson LJ, Mushtaq M, Watts T, et al. A re-audit of pulmonary function laboratories in the West Midlands. Respir Med 1998;92:1155–1162.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  5. Chavannes N, Schermer T, Akkermans R, et al. Impact of spirometry on GPs' diagnostic differentiation and decision-making. Respir Med 2004;98:1124–1130.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Permissions
Right arrowRequest Permissions
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chavannes, N. H.
Right arrow Articles by Schermer, T. R. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chavannes, N. H.
Right arrow Articles by Schermer, T. R. J.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS