Point of care microspirometry to facilitate the COPD diagnostic process in primary care: a clustered randomised trial

Abstract

We studied if pre-bronchodilator FEV1/FEV6 determinations with microspirometers by GPs improve the diagnostic process for COPD in a 6–8 month clustered randomised controlled trial in Dutch general practices (http://www.trialregister.nl: NTR4041). GPs allocated to microspirometry (MI) used COPD-6® microspirometers in patients ≥50 years old with a smoking history and respiratory complaints that could indicate undiagnosed COPD and ask to refer patients for full spirometry if MI was positive (FEV1/FEV6 <0.73). Introduction of the COPD-6® was postponed in the usual care (UC) group. GPs of both study arms were asked to list all patients that fulfilled study criteria and at the end of the study we screened the electronic medical record system for number of patients that fulfilled study criteria and visited their GP within the study period. Main end point was a documented diagnostic conclusion of COPD within 3 months after the patient’s visit. We used multilevel logistic regression with correction for relevant covariates. Next, we described the process of care. 21 practices (88 GPs) participated and 416 possible undiagnosed COPD patient visited these practices in the study period. 78 (of 192 visiting) subjects were listed by MI GPs and diagnostic conclusions were documented in 77%, compared to 61 listed (of 224 visiting) subjects and 44% with documented diagnostic conclusions by UC GPs (Odds Ratio: OR: 4.3, 95%CI: 1.6–11.5). Microspirometry improved the diagnostic process for possible underlying COPD in patients who consulted their GP with respiratory symptoms, but the majority of possible undiagnosed COPD patients remained unrecognised by GPs.

Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective

“…40 A staged approach using both questionnaires (such as the COPD Diagnostic Questionnaire) followed by a handheld microspirometry might be the best diagnostic approach with a sensitivity and specificity of 72% and 97%, respectively. 41 Abnormal handheld microspirometry results should always be followed by a conventional pulmonary work-up, including standard spirometry and body plethysmography to detect both airway obstruction as well as hyperinflation.…”

Ten Research Questions for Improving COPD Care in the Next Decade

“…Several initiatives have been proposed to increase the suspicion, including validated questionnaires [33,34], micro-spirometers [35], or simplified on FEV 6 -based devices like the COPD-6 [36] or Piko-6 [37]. Additionally, another setting worth exploring in the near future is the hospital admission as an opportunity to detect cases.…”

Measuring disease activity in COPD: is clinically important deterioration the answer?

“…The majority of CID analyses to date have used pre-bronchodilator FEV 1 to detect objective worsening in lung function, but due to the time-consuming nature of diagnostic spirometry, alternative approaches to assess meaningful deterioration are required to enable efficient clinical assessment of CID status. One possible alternative that should be evaluated in future studies is the use of small handheld microspirometry devices to measure FEV 1 /FEV 6 ratio, where FEV 6 is defined as FEV in 6 s, a surrogate for forced vital capacity [56]. Furthermore, the SGRQ is too complex and time consuming for routine use, but the available evidence suggests that the CAT could be substituted as the measure of health status.…”