Use of spirometry in family practice in Canada; results of a nationwide survey

Kaplan, Alan; Levitz, Suzanne

doi:10.1183/13993003.congress-2016.pa3938

Cited by 4 publications

(6 citation statements)

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“…For instance, statins have shown an effect on all-cause mortality rates of patients with COPD [9]. These factors should all reduce both the personal and societal burden of the disease, but despite substantial effort and investment, the implementation of quality spirometry, the essential test in COPD diagnosis, is deficient because of multiple barriers [10] and limitations [11].…”

Section: Introductionmentioning

confidence: 99%

Screening for COPD: the gap between logic and evidence

Kaplan

Thomas

2017

Eur Respir Rev

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Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on all smokers to detect COPD. While this would pick up cases of COPD, results of studies of its effect on COPD end-points such as exacerbations, hospitalisations and mortality are disappointing. As such, aggressive case finding of COPD by screening for symptoms that patients may not themselves perceive is very important in primary care, with subsequent spirometry defining the diagnosis.We also have to separate out population screening from individual patient interactions. Performing spirometry, even on a truly asymptomatic patient, may allow earlier diagnosis and modification of risk factors such as smoking (mostly) and exacerbation risk. It also recognises patients with early disease who are at high risk of comorbidities such as cardiac illness, such that appropriate treatment strategies can be implemented. Making a diagnosis, and even the fact of worrying about such a diagnosis, can affect the motivational level of the individual patient to cease smoking; all patients should of course be counselled to stop smoking. As such, consider the individual patient in front of you for unrecognised symptoms and therefore unrecognised illness, as making a diagnosis earlier can allow the institution of care, including smoking cessation, vaccination, bronchodilators and comorbidity management.

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Section: Introductionmentioning

confidence: 99%

Screening for COPD: the gap between logic and evidence

Kaplan

Thomas

2017

Eur Respir Rev

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“…In accordance with the ATS and ERS recommendations for selecting healthy subjects, 21 patients were eligible if they fulfill all following criteria: (1) aged 2-17 years, (2) no personal history of wheezing or asthma (based on the International Study of Asthma and Allergies in Childhood [ISAAC] questionnaire), 22 (3) no personal history of allergic rhinitis or dermatitis (ISAAC questionnaire), 22 (4) no history of in utero or passive smoking (i.e., exposure to smoking in the first 2 years of life or in the past year), (5) no low birth weight (<1500 gr) or neonatal ventilation, (6) no other chronic respiratory disease, (7) no recent (<4 weeks) upper respiratory tract infection, (8) no contraindication in obtaining oscillometry measurement (e.g., face trauma); (9) no conditions (e.g., severe scoliosis) or medication (e.g., betablockers) potentially interfering with measurement validity; (10) no chronic infection potentially transmitted by respiratory droplets or saliva, (11) no obesity (body mass index [BMI] <97%), 23 and ( 12) good cooperation with oscillometry measurement using a mouthpiece on a test trial.…”

Section: Study Subjectsmentioning

confidence: 99%

“…5,6 Even in older children, there is suboptimal use of spirometry by community physicians in part because lack of access at the point-of-care, as well as discomfort in procedure execution and interpretation of results. [7][8][9] In spirometryuntested children, asthma diagnosis and control monitoring rely primarily on history, clinical observation, and treatment response, an approach not recommended in individuals 6 years and older, due to the risk of under or over-diagnosis. 10,11 Several alternative lung function tests are available to document airway obstruction, reversibility, and hyperactivity, but their use in clinical practice is limited to few specialized centers.…”

Section: Introductionmentioning

confidence: 99%

“…As spirometry is largely dependent on patient cooperation, preschoolers are frequently unable to cooperate, as well as children of all ages suffering an exacerbation 5,6 . Even in older children, there is suboptimal use of spirometry by community physicians in part because lack of access at the point‐of‐care, as well as discomfort in procedure execution and interpretation of results 7–9 . In spirometry‐untested children, asthma diagnosis and control monitoring rely primarily on history, clinical observation, and treatment response, an approach not recommended in individuals 6 years and older, due to the risk of under or over‐diagnosis 10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Reference values for respiratory sinusoidal oscillometry in children aged 3 to 17 years

Ducharme

Smyrnova

Lawson

et al. 2022

Pediatric Pulmonology

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Background New oscillometry devices allowing quantification of respiratory function using tidal breathing are commercially available, but reference equations are lacking for the multiethnic Canadian pediatric population. Methods We conducted a prospective cross‐sectional study of healthy children carefully selected for absence of asthma, atopy, tobacco smoke, obesity, prematurity, and recent respiratory infection. Triplicate measures were obtained of respiratory system resistance (Rrs) and reactance (Xrs), area under the reactance curve (AX) and resonant frequency (Fres) on four signals, whose testing order was randomized: two signals on the Resmon Pro Full (8 Hz and 5‐11‐19 Hz) and two signals on the tremoflo C‐100 (5–37 Hz and 7–41 Hz). Feasibility was defined as the ability to obtain valid reproducible results. Prediction equations and 95% confidence intervals were derived for whole‐ and within‐breath Rrs and Xrs and for AX and Fres, using linear regression or Generalized Additive Models for Location, Scale and Shape. Results Of 306 children randomized, valid and reproducible results on ≥1 signal were obtained in 299 (98%) multiethnic (69% Caucasians: 8% Black: 23% Others) children aged 3–17 years, 91–189 cm tall. Standing height was the strongest predictor with no significant effect of sex, age, body mass index or ethnicity. Significant within‐patient differences were observed between Resmon Pro and tremoflo C‐100 measurements, justifying the derivation of device‐specific reference equations. Conclusion Valid reproducible oscillometry measurements are highly feasible in children aged 3 years and older. Device‐specific reference equations, valid for our multiethnic population, are derived.

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“…The future of spirometry Appreciating the complex and sometimes controversial 175-year history of spirometry, we must now ask what the future holds for this important tool. For one, optimal uptake and use of spirometry is still not ideal, and there remains significant health equity disparities preventing broader access to spirometry [91,110,117,118]. In primary care, for example, the percentage of spirometry performed according to ATS/ERS criteria is often less than 50%, and agreement between general practitioners and pulmonologists on diagnosis is often low [117].…”

Section: The Intersection Of Spirometry and Racementioning

confidence: 99%

Exploring the 175-year history of spirometry and the vital lessons it can teach us today

et al. 2021

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175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow–volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.

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Use of spirometry in family practice in Canada; results of a nationwide survey

Cited by 4 publications

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Screening for COPD: the gap between logic and evidence

Screening for COPD: the gap between logic and evidence

Reference values for respiratory sinusoidal oscillometry in children aged 3 to 17 years

Exploring the 175-year history of spirometry and the vital lessons it can teach us today

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