The value of spirometry for primary care: Asthma and COPD

Schermer, Tjard; Schayck, Onno van; Weel, Chris van; Folgering, H.T.M.; Bottema, Ben; Jacobs, Annelies

doi:10.1038/pcrj.2000.20

Cited by 17 publications

(13 citation statements)

References 20 publications

(35 reference statements)

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“… poor implementation of respiratory guidelines in the primary care setting; 16 , 17 under‐diagnosis or under‐recognition of respiratory disease; 18 a lack of effective therapies of proven benefit for patients with mild‐to‐moderate COPD; 19 the fact that the majority of guidelines are based on moderate‐to‐severe disease (the area in which the major costs of treatment are incurred) and are thus considered not relevant to the management of mild‐to‐moderate disease; physicians’ preference for using clinical judgement for patient disease management rather than collections of clinical guidelines that they may perceive to be insufficiently user‐friendly; and dissimilarity between patients presenting to primary care and those included in the randomised controlled trials on which the evidence for guideline development is based. …”

Section: Resultsmentioning

confidence: 99%

Models of chronic disease management in primary care for patients with mild‐to‐moderate asthma or COPD: a narrative review

Cranston

Crockett

Moss

et al. 2008

Medical Journal of Australia

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Objective: To review the literature for any promising strategies for the primary care management of mild‐to‐moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. Methods: Using “MeSH” terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta‐analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. Results: 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild‐to‐moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse‐run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse‐run COPD clinics could not be found. Self‐management education, GP review and action plans may produce short‐term benefits for asthma patients, particularly those with moderate‐to‐severe disease, but the evidence for a similar approach to patients with mild‐to‐moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care — partly because most guidelines are based on moderate‐to‐severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. Conclusion: The role of primary health care in management of mild‐to‐moderate asthma and COPD requires further investigation using randomised controlled trials.

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Section: Resultsmentioning

confidence: 99%

Models of chronic disease management in primary care for patients with mild‐to‐moderate asthma or COPD: a narrative review

Cranston

Crockett

Moss

et al. 2008

Medical Journal of Australia

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“…After a half-day training session, 84% of the spirometric curves obtained appeared to be of sufficient quality to determine FEV1 [42], according to American Thoracic Society criteria [43]. FEV1 measurements in general practice can be performed by the practice assistant, after a relatively brief instruction and training session [44].…”

Section: What Could Be the Reason For Underdiagnosis?mentioning

confidence: 99%

Detection of asthma and chronic obstructive pulmonary disease in primary care

Schayck¹,

Chavannes²

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) and asthma are major health problems, the number of patients with these diseases is still rising and only 25–50% of these patients are known to their doctors.Lung function gradually decreases in COPD and asthmatic patients during their lives. Due to adaptation of the patients or due to the doctor being unaware of the symptoms, COPD is often diagnosed late in its course and when finally diagnosed, lung function is often relatively poor. Underdiagnosis and consequently undertreatment might play an important role in the increase in morbidity and mortality as a result of COPD and asthma. Early detection and treatment might improve the long-term prognosis of these patients and this secondary prevention may also prevent irreversible loss of function.The identification of patients is useless if no effective preventive measures are available. In asthma, inhaled corticosteroids have been shown to have distinct effects on the progression of the disease. However, in COPD inhaled corticosteroids have only been shown to have some effects and the long-term effects on lung function have been disappointing. At present, the most effective treatment available for COPD is the cessation of smoking. It appears that a smoker at risk of developing COPD is more motivated to stop smoking than someone who is not at risk and this may help a physician in encouraging an attempt to quit.General practitioners appear to be already using this knowledge, as they seem more likely to advise smokers to quit smoking if they perceive their problems to be smoking related.

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“…Alternatives could include utilising primary care diagnostic services or hospital-based laboratories, although there may be certain disadvantages, including barriers to access (table 1) [10]. Furthermore, relevant spirometric indices measured by trained family physicians or their staff may be marginally higher compared with pulmonary function laboratories [14].…”

Section: Organising Spirometry In Primary Carementioning

confidence: 99%

“…In primary care, spirometry is often, wrongly, regarded as a noninvasive simple screening test. However, it is apparent that careful consideration needs to be given to a number of aspects including selection and maintenance of equipment, optimal performance of the test by both patient and operator, adherence to standard criteria for acceptability and repeatability, appropriate selection of normal predicted values, and careful and informed interpretation of the results [10]. The newer generation electronic spirometers facilitate the adoption of acceptability and reproducibility criteria in primary care, but this should not engender complacency.…”

Section: Spirometry Quality Assurancementioning

confidence: 99%