Enhancing the diagnosis and management of COPD in Primary care

Partridge, Martyn R

doi:10.1186/2049-6958-9-62

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…Having appropriate reference norms is vital in a multi-ethnic population, especially during the clinical decision-making process at the primary healthcare level for physicians caring for patients in rural and remote communities. [33][34][35] 35 Nevertheless, restrictive impairment was the most common spirometry impairment observed among our Indigenous Australian sample, particularly when either CT or CXR is negative for airway diseases.…”

Section: Discussionmentioning

confidence: 83%

“…Due to the high prevalence of abnormalities identified on spirometry even among the ‘no airway disease’ group (restrictive impairment in 71%, AO in 17–22%, mixed impairment in 19%, BDR T in 13%, and BDR U in 27%), it is challenging to use standard spirometric threshold values as predictors of radiologically defined COPD or bronchiectasis. Having appropriate reference norms is vital in a multi‐ethnic population, especially during the clinical decision‐making process at the primary healthcare level for physicians caring for patients in rural and remote communities 33–35 . Nevertheless, restrictive impairment was the most common spirometry impairment observed among our Indigenous Australian sample, particularly when either CT or CXR is negative for airway diseases.…”

Section: Discussionmentioning

confidence: 96%

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Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Howarth

Gahreman

Saad

et al. 2023

Internal Medicine Journal

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BackgroundThe majority of Indigenous Australians reside in non‐urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X‐ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT‐defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported.AimTo evaluate spirometry indices against CXR and CT findings among adult Indigenous Australians.MethodsIndigenous patients who had undergone a spirometry test between 2012 and 2020 and had a CXR or chest CT scan assessed for the presence (+)/absence (−) of airway diseases were included in this study.ResultsOf 643 patients (57% female, 31% remote/very remote), 364 (57%) had CT and CXR available. Patients who were ‘CT− and CXR−’ for airway diseases (48%) recorded a mean FVC, FEV1 and FEV1/FVC of 61%, 59% and 0.76 compared to 57%, 49% and 0.66 in the ‘CT+ and CXR−’ group and 53%, 39% and 0.58 in the ‘CT+ and CXR+’ group. CXR showed sensitivity (44%) and specificity (88%), while spirometry showed 62% and 77% compared to CT. Spirometry demonstrated predominately restrictive impairment among ‘CT− and CXR−’ and mixed/obstructive impairment among ‘CT+ and CXR−’ and ‘CT+ and CXR+’ groups.ConclusionIndigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Howarth

Gahreman

Saad

et al. 2023

Internal Medicine Journal

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“…In fact, spirometry changed the physician’s clinical impressions and treatments for approximately one-third of cases. 20 , 67 – 69 Another major point is that Greece presents high variability in the distribution of pulmonologists, and therefore, significantly different rates may be observed among regions independently of population risk factors. 70 Many PHCs are located in the remote areas where access to specialists is limited.…”

Section: Discussionmentioning

confidence: 99%

“… 19 In particular, PHC is the gateway to the health system and is expected to resolve up to 85% of health demands as well as to offer comprehensive care coordinated with the other levels of health care. 20 …”

Section: Introductionmentioning

confidence: 99%

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist

Stafyla¹,

Kotsiou²,

Deskata³

et al. 2018

COPD

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BackgroundThe diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program.MethodsA study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers.ResultsA total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider’s prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy.ConclusionWe reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners’ nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece.

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“…Respiratory medicine, for example, have recognised intuitive gains from seeing patients with chronic obstructive pulmonary disease (COPD) earlier in their illness trajectory and have accepted this as part of the narrative of the OVERVIEW Author: A consultant and honorary associate professor in medicine of older people, Nottingham University Hospitals NHS Trust, Nottingham, UK efficacious intervention of providing integrated care for this particular long-term condition. 4 It is possible that these differing narratives represent differing psychologies, or psychopathologies, within individual specialties. They may also reflect the divergent nature of the community interventions.…”

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confidence: 99%

Editorial comment: Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England

Gordon

2015

Future Hospital Journal

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Enhancing the diagnosis and management of COPD in Primary care

Cited by 3 publications

References 8 publications

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist

Editorial comment: Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England

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