Diagnostic Spirometry in Primary Care: Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations. A General Practice Airways Group (GPIAG)1 document, in association with the Association for Respiratory Technology &amp; Physiology (ARTP)2 and Education for Health3 1www.gpiag.org 2 www.artp.org 3 www.educationforhealth.org.uk

Levy, Mark L; Quanjer, Philip H.; Booker, Rachel; Cooper, Brendan; Holmes, Steve; Small, Iain

doi:10.4104/pcrj.2009.00054

Cited by 184 publications

(114 citation statements)

References 114 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…Their handling was simple and they were considered low maintenance. However, the choice of reference values in the menu and the clicking of participants' information were difficult, and absence of a real-time display of spirometric curves (which has recently been recommended 31 ) may have generated a higher number of invalid spirometry readings. Fieldworkers passed a quality control test, but the yield of valid spirometry readings (67.3%) was medium to low compared to that found in similar studies.…”

Section: • Database and Document Repositorymentioning

confidence: 99%

Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study

Soriano¹,

Yáñez²,

Renom

et al. 2010

Primary Care Respiratory Journal

View full text Add to dashboard Cite

Aims: We describe the set-up of a population-based study focussed on respiratory conditions, and describe a pilot study -the PULmons SAns Illes Balears (PULSAIB) study -aimed at investigating the natural history of COPD, obstructive sleep apnoea (OSA), and other common chronic diseases.Methods: A cross-sectional study was designed to survey two fieldwork areas, one rural and one urban, in the Balearic Islands, Spain. Tests conducted included a questionnaire, spirometry with post-bronchodilator (PBD) test, and portable respiratory polygraphy. Results:We assessed all processes and tools to be used, and piloted them in 175 participants from Bunyola (rural) and 130 participants from the Son Pizà area (urban). Within this first cross-sectional assessment of the Balearic population aged 30 to 80 years, we report the prevalence of airflow limitation defined as a PBD FEV1/FVC ratio <0.7 and the prevalence of OSA defined as an apnoea-hypopnoea index (AHI) >10/hour. Conclusion:A cohort study in the Balearic population to investigate the natural history of COPD and OSA is feasible.

show abstract

Section: • Database and Document Repositorymentioning

confidence: 99%

Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study

Soriano¹,

Yáñez²,

Renom

et al. 2010

Primary Care Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…The American Thoracic Society/European Respiratory Society guidelines published in 2005, and the more recent recommendations on spirometry in the primary-care setting, have largely reiterated that stand. 5,6 However, several old and recent international initiatives, mostly focusing on COPD, still recommend the use of a fixed percentage for this purpose. [7][8][9] The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, first published in 2001 and thereafter updated annually, define COPD as a post-bronchodilator FEV 1 /FVC below 0.70.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Lower Confidence Limit to the Fixed-Percentage Method for Assessing Airway Obstruction in Routine Clinical Practice

et al. 2011

View full text Add to dashboard Cite

BACKGROUND: Although the statistically derived lower limit of normal (LLN) for the ratio of FEV 1 to FVC is considered superior to a fixed cutoff value (such as 0.70) for diagnosing airway obstruction, the fixed-cutoff method continues to be used and advocated. OBJECTIVE: To evaluate the misclassification of spirometrically determined airway obstruction arising from the use of the fixed-percent method, in comparison to the LLN method for FEV 1 /FVC. METHODS: We reviewed 27,307 spirometry records from adult men, and diagnosed airway obstruction based on the LLN (predicted value minus 1.645 times the standard error of estimate from a north Indian reference equation for FEV 1 /FVC) and based on a fixed cutoff of 0.70. We computed agreement and discordance between the two methods, and determined the sensitivity, specificity, and predictive values of the fixed-percent method in identifying true obstruction. RESULTS: The results were discordant in 1,622 subjects (6%). Overall agreement between the two methods was good (kappa estimate 0.869), but worsened considerably with advancing age. 1,290 subjects (5%) who were deemed normal with the LLN method were diagnosed as having airway obstruction with the fixed-percentage method. Overall the sensitivity, specificity, and positive predictive value of the fixed-percentage method were 0.963, 0.929, and 0.871, respectively. Specificity and positive predictive value decreased sharply with advancing age. CONCLUSIONS: The negative age-dependence of FEV 1 /FVC results in over-diagnosis of airway obstruction in middle-aged and elderly men, and under-diagnosis in young men, with the fixed-percentage method. Airway obstruction should be assessed with the LLN of FEV 1 / FVC, with the LLN derived from appropriate reference equations.

show abstract

“…The diagnosis is based on the history, signs and symptoms, 33,34 and whilst the presence of atopy may strengthen the probability of asthma, diagnostic spirometry is not practical under the age of 5 years. 35 The IPCRG guidelines suggest a range of symptom-based tools and investigations including peak flow monitoring, spirometry, reversibility testing and challenge tests, 36 and a recent international statement summarises the technical details. 37 Information on the sensitivity, specificity, positive and negative predictive value of such tools in primary care settings is needed to inform best practice.…”

Section: Diagnosismentioning

confidence: 99%

“…[143][144][145][146][147][148] This fixed ratio cutoff has the advantage of simplicity but does not allow for the natural reduction in the ratio due to lung ageing, thus risking under-diagnosis in younger patients and over-diagnosis in the elderly. 35 The use of the lower limit of normal (LLN) may improve diagnostic precision but accurate reference ranges are needed in the older patients. 155 Primary care spirometry has been criticised as being underused, 156,157 and in many countries is not available outside specialist centres.…”

Section: Diagnosis Of Copd In Primary Carementioning

confidence: 99%

“…Concerns about the quality of spirometry 158 have recently been addressed by a UK document recommending standards for spirometry undertaken in primary care practice. 35 Validated questionnaires have been developed to support the diagnosis of COPD. [159][160][161] Practical experience with these tools is limited and it is not yet clear how such questionnaires can best be used in clinical practice -e.g.…”

Section: Diagnosis Of Copd In Primary Carementioning

confidence: 99%

See 1 more Smart Citation

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

Pinnock

Thomas

Tsiligianni

et al. 2010

Primary Care Respiratory Journal

View full text Add to dashboard Cite

Cited by 184 publications

References 114 publications

Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study

Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study

Comparison of the Lower Confidence Limit to the Fixed-Percentage Method for Assessing Airway Obstruction in Routine Clinical Practice

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

Contact Info

Product

Resources

About