Spirometry in primary care case-identification, diagnosis and management of COPD

Price, David; Crockett, Alan; Arne, Mats; Garbe, B.; Jones, Rupert; Kaplan, Alan; Langhammer, Arnulf; Williams, Siân; Yawn, Barbara P.

doi:10.4104/pcrj.2009.00055

Cited by 59 publications

(54 citation statements)

References 34 publications

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“…There are several barriers to overcoming this challenge, including the different effects of interventions on individual patients due to heterogeneity within the COPD population, poor relationships between symptoms and indices of disease severity, and limited data on the effects of current management on long-term outcomes in COPD. 1,2 The pathophysiology of COPD is potentially more complex than that of many other chronic disorders because of considerable disease heterogeneity 1 and weak relationships between objective measurements used in daily practice (such as the forced expiratory volume in one second [FEV 1]) and patient-centred outcomes (such as quality of life and walking distance). 2 Consequently, more specific information about patient characteristics and more robust, directly informative clinical measurements may be needed to guide COPD management.…”

Section: Introductionmentioning

confidence: 99%

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A new perspective on optimal care for patients with COPD

Postma

Anzueto²,

Calverley

et al. 2011

Primary Care Respiratory Journal

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Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term 'here-and-now' goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD. We propose a new paradigm to achieve 'optimal COPD care' based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: 'best current control' and 'future risk reduction'. This broader approach to disease management should result in improved care for every COPD patient now and into the future.

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Section: Introductionmentioning

confidence: 99%

“…2 Nevertheless, COPD management in primary care focuses on immediate symptom reduction, mainly resulting from the perceived ineffectiveness of pharmacological treatments to change the progressive course of COPD and the opinion that smoking cessation is the only disease modifier. 3,4 Although new …”

Section: Introductionmentioning

confidence: 99%

A new perspective on optimal care for patients with COPD

Postma

Anzueto²,

Calverley

et al. 2011

Primary Care Respiratory Journal

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“…12 The International Primary Care Respiratory Group (IPCRG) have recommended a diagnostic process where all patients over 35 years of age should be evaluated for their risk of developing COPD by completing the CDQ and/or 'case-identification' spirometry prior to standard diagnostic spirometry. 28 The IPCRG assigned the lower cut-off point as a singular cut-off point for the CDQ in this diagnostic process, with subjects scoring >17 going on to have diagnostic spirometry. 12,28 Implications for future research, policy and practice Further research is needed on the use of the CDQ as a selection tool for proceeding to spirometry.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

“…28 The IPCRG assigned the lower cut-off point as a singular cut-off point for the CDQ in this diagnostic process, with subjects scoring >17 going on to have diagnostic spirometry. 12,28 Implications for future research, policy and practice Further research is needed on the use of the CDQ as a selection tool for proceeding to spirometry. This could potentially save both time and money if found to be effective.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Validation of the COPD Diagnostic Questionnaire in an Australian general practice cohort: a cross-sectional study

Stanley

Hasan²,

Crockett

et al. 2014

Primary Care Respiratory Journal

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Background: The gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD) is spirometry, but there are barriers to its use in primary care. Aims: To externally validate the COPD Diagnostic Questionnaire (CDQ) as a diagnostic tool in patients at increased risk in Australian general practice and to compare its performance with other CDQ validation studies. Methods: Patients were recruited from 36 general practices in Sydney, Australia. Former or current smokers aged 40–85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse. The CDQ was collected and pre- and postbronchodilator spirometry was performed. Cases for whom complete CDQ data were present and the spirometry met quality standards were analysed. Results: Of 1,631 patients who attended case-finding recruitment, 1,054 (65%) could be analysed. Spirometry showed 13% had COPD. The ability of the CDQ to discriminate between patients with and without COPD was fair, represented by the area under the receiver operating characteristic curve of 0.713. With a CDQ cut-off point value of 16.5 the sensitivity was 80% and specificity 47% and, at a cut-off point value of 19.5, the sensitivity was 63% and specificity 70%. Conclusions: The CDQ did not discriminate between patients with and without COPD accurately enough to use as a diagnostic tool in patients at increased risk of COPD in Australian general practice. Further research is needed on the value of the CDQ as a tool for selecting patients for spirometry.

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“…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. Concerns about the quality of spirometry 158 have recently been addressed by a UK document recommending standards for spirometry undertaken in primary care practice.…”

Section: Diagnosis Of Copd In Primary Carementioning

confidence: 99%