Effect of primary care spirometry on the diagnosis and management of COPD

¹ Division of Infection and Immunity, School of Clinical Sciences, University of Liverpool, Liverpool, United Kingdom
² Aintree Chest Centre, University Hospital Aintree, Liverpool, United Kingdom

	Abstract

Primary care spirometry has been promoted to facilitate accurate diagnosis of chronic obstructive pulmonary disease. The study examines whether improving rates of diagnosis leads to improvements in pharmacological and non-pharmacological management.

From 1999 to 2003 we provided an open access spirometry and reversibility service to a local primary care area and 1508 subjects were referred. 797 (53%) had pre-bronchodilator airflow obstruction (AFO). 19.3% of the subjects who had reversibility testing were no longer obstructed post-bronchodilator. We examined the results and records of a sub-group of 235 subjects with post-bronchodilator AFO.

One hundred and thirty of the 235 subjects received a new diagnosis, most commonly COPD. The patients with COPD were significantly under treated before spirometry and testing led to a significant increase in the use of anti-cholinergics (37% vs. 18%), long-acting beta agonists (25% vs. 8%) and inhaled steroids (71% vs. 52%). More than three quarters of smokers received smoking cessation advice but very few were referred for pulmonary rehabilitation.

Primary care spirometry not only increases rates of COPD diagnosis but also leads to improvements in COPD treatment. Use of bronchodilator reversibility testing in this setting may be important to avoid misdiagnosis.

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