COPD case finding by spirometry in high-risk customers of urban community pharmacies: A pilot study

Castillo, Diego; Guayta, Rafael; Giner, Jordi; Burgos, Felip; Capdevila, Cristina; Soriano, Joan B.; Barau, Mercè; Casán, Pere

doi:10.1016/j.rmed.2008.12.022

Cited by 70 publications

(105 citation statements)

References 27 publications

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“…Comparison between LLN and GOLD criteria Our data confirmed that the use of a fixed ratio (FEV1/FVC ,0.7) can lead to an overestimation of airway obstruction: NHANES III # [10] Korea # [11] ERS tent # GOLD BOLD ¶ [6] Poland # [20] LLN Korea # [11] Poland # [9] ERS tent # LLN NHANES III # [10] b) Poland # [19] Belgium # [18] Netherlands ¶ [16] Sweden ¶ [27] Israel ¶ [17] ERS tent # Barcelona ¶ [28] overall, using the GOLD criteria compared with the LLN, there was an overestimation of airway obstruction of ,64% (20.3% versus 12.4%). In particular, the GOLD criteria overestimated the mild-to-moderate stages when considering the severity levels; however, it was comparable to LLN criteria in severe-tovery severe stages.…”

Section: Discussionsupporting

confidence: 71%

“…In a primary care setting in Belgium, screening by spirometry showed a 46.6% prevalence of airway obstruction in current smokers (aged 40-70 yrs; n5146), of which 29.5% were newly detected [18]. A quite different screening programme was performed in Barcelona (Spain) in 100 pharmacy customers (aged .40 yrs) with respiratory symptoms and/or a history of smoking; they were invited to perform spirometry and 24% demonstrated airway obstruction [28].…”

Section: Discussionmentioning

confidence: 99%

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The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Maio¹,

Sherrill²,

MacNee³

et al. 2012

Eur Respir J

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In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing tent during the annual ERS Congresses in 2004-2009. Spirometry was performed during the ERS Congresses in volunteers; all participants answered a simple, brief questionnaire on their descriptive characteristics, smoking and asthma. Portable spirometers were freely provided by the manufacturer. Nurses and doctors from pulmonary departments of local hospitals/universities gave their service for free. Lower limit of normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for diagnosing and grading airway obstruction were used.Of 12,448 participants in six congress cities, 10,395 (83.5%) performed acceptable spirometry (mean age 51.0¡18.4 yrs; 25.5% smokers; 5.5% asthmatic). Airway obstruction was present in 12.4% of investigated subjects according to LLN criteria and 20.3% according to GOLD criteria. Through multinomial logistic regression analysis, age, smoking habits and asthma were significant risk factors for airway obstruction. Relative risk ratio and 95% confidence interval for LLN stage I, for example, was 2.9 (2.0-4.1) for the youngest age (f19 yrs), 1.9 (1.2-3.0) for the oldest age (o80 yrs), 2.4 (2.0-2.9) for current smokers and 2.8 (2.2-3.6) for reported asthma diagnosis.In addition to being a useful advocacy tool, the spirometry tent represents an unusual occasion for early detection of airway obstruction in large numbers of city residents with an important public health perspective.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Maio¹,

Sherrill²,

MacNee³

et al. 2012

Eur Respir J

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“…A study conducted with community pharmacists found that 73% of spirometries carried out by pharmacists were of acceptable quality, as judged by lung function experts in an acute setting. 186 Ongoing challenges related to the selection of a suitable spirometric screening test and to maintaining the quality of spirometric tests in primary care. A further study investigating the quality of spirometry in primary care found that > 15% of the tests being sent from primary care to specialists to analyse lacked complete data.…”

Section: Skillsmentioning

confidence: 99%

“…186 Ongoing challenges related to selection of a suitable spirometric screening test and to maintaining the quality of spirometric tests in primary care.…”

mentioning

confidence: 99%

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…To further reduce underdiagnosis, the implementation and wider use of spirometry screening in all settings, including quality spirometry in primary care [42], pharmacies [43], and elsewhere, require further research and resources [44].…”

Section: Limitationsmentioning

confidence: 99%

Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007

Soriano¹,

Ancochea²,

Miravitlles³

et al. 2009

Eur Respir J

142

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We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart.We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n54,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n53,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions.COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p,0.05) within this 10-yr frame.The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

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COPD case finding by spirometry in high-risk customers of urban community pharmacies: A pilot study

Cited by 70 publications

References 27 publications

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007

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