Use of an open access spirometry service by general practitioners

Abstract

Summary Aims:To understand better which patients with which diagnoses or suspected diagnoses are referred for spirometry in primary care, and to assess whether all such referrals are appropriate. Methods: 200 consecutive patient referrals to an open access spirometry service from ten local general practices were evaluated by perusing the request forms, and analysis of the spirometry results and the report sent to the general practitioner (GP).Results: 51% of all referrals had suspected or stated COPD, but airway obstruction was demonstrated in only 53% of cases. A minority had a degree of reversibility which suggested an additional asthma component at least. Airway obstruction was rarely demonstrated in patients referred with stated or suspected asthma. 117 patients were referred with stated or suspected airway disease but had no evidence of airway narrowing on testing. 14.5% of these had an unexpected small lung (restrictive) disorder. Six of these had a BMI of more than 30. Conclusion: Most referrals with stated or suspected COPD were highly appropriate since spirometry is required in order to establish the correct diagnosis. Referral of patients with suspected asthma is less likely to be helpful, and a period of home peak flow monitoring may be more useful. Restrictive disorders can be confused with airway disorders, and obesity may be underestimated as a cause of breathlessness.

Enhancing the accuracy of respiratory diagnoses in primary care: a report on the establishment of a Community Respiratory Assessment Unit

“…COPD represents the major reason for referral of patients to this service and the results suggest that if such referral had not taken place, mistaken diagnoses would have occurred in a third of cases and there was a potential for significant inappropriate medications to be given to patients in whom the diagnosis was not confirmed by spirometric demonstration of airway narrowing. As in a previous study [2], referral for spirometry was not shown to be so helpful for those with suspected or stated asthma, and this often reflected referral of patients who were well at the time of referral or referral of those who had already been started on anti-inflammatory therapy. Under such circumstances it is impossible to tell whether the normality of the results reflected benefit of the treatment or the absence of a diagnosis of asthma.…”

“…Spirometry is one tool which might enhance diagnostic accuracy and we have previously shown that without use of spirometry, mistaken diagnoses are likely in primary care [2]. Various reports have been published of the appropriateness, usefulness and accuracy of spirometry performed in primary care [3], and of different ways of providing such a service [4].…”

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

“…Quantitative studies Sp1,Sp2,Sp16,Sp19,Sp52,Sp54,Sp55,Sp62,Sp63,Sp87 Sp8,Sp9,Sp15,Sp43,Sp75,Sp87,Sp89,Sp90,Sp92,Sp97 Sp6,Sp14,Sp16,Sp18,Sp27,Sp36,Sp47,Sp49,Sp55,Sp60,Sp61,Sp64,Sp88,Sp100 Sp2,Sp57,Sp59,Sp68,Sp108 Qualitative studies…”

The validity of diagnostic support of an asthma/COPD service in primary care

“…Scotland has outreach spirometry services; 12 in the Netherlands there are asthma/COPD services; and, starting from direct access to a pulmonary laboratory in 1990, 13 open-access spirometry is used in the UK. 14 While retaining final responsibility for the care of their patients with asthma/COPD, GPs can delegate diagnostic procedures, follow up, and monitoring procedures to these services. A main issue is whether the general practice (and the patient) can rely on the validity of this procedure.…”