Chest
Volume 132, Issue 4, October 2007, Pages 1162-1168
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ORIGINAL RESEARCH
ASTHMA
Spirometry Can Be Done in Family Physicians' Offices and Alters Clinical Decisions in Management of Asthma and COPD

https://doi.org/10.1378/chest.06-2722Get rights and content

Background

Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care.

Object

To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry.

Design

A before-and-after quasiexperimental design.

Setting

Three hundred eighty-two patients from 12 family medicine practices across the United States.

Participants

Patients with asthma and COPD, and staff from the 12 practices.

Measurements

Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing.

Results

Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD.

Discussion and conclusions

US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.

Section snippets

Materials and Methods

Using a before-and-after quasiexperimental design, spirometers (Easy One; ndd Medizintechnik AG; Zurich, Switzerland) were introduced into 12 nonacademic family medicine practices without prior use of in-office spirometry. The practices were randomly selected from 35 of the 112 practices of the American Academy of Family Physicians National Research Network that volunteered for this study.2122 From each practice, a physician and the person who would administer spirometry participated in an

Results

The 12 practice investigators were all family physicians working in communities with populations ≤100,000. The 382 patients were mainly women (63%) and adults (76%) with a mean age of 46.1 years (SD, 19.9 years; range, 7 to 89 years). Overall, 248 patients (65%) had a previous diagnosis of asthma only, 100 patients (26%) had COPD only, and 32 patients (8%) had both asthma and COPD.

Of the 382 patients, 2 patients withdrew before testing and 12 others never completed a test maneuver. Ten of these

Discussion

Incorporation of spirometry testing into these family medicine practices led to spirometry testing with acceptable levels of technical quality and concordant interpretation and was followed by management changes for almost half of the patients. Poor technical quality and low rates of concordant interpretations were limited primarily to two practices (G and J in Fig 2).

Our results support previous work61117303132 demonstrating moderate-to-high levels of technical adequacy and ability to accuracy

ACKNOWLEDGMENT

The authors appreciate the dedicated work of the staff of the National Research Network of the American Academy of Family Physicians, especially Jennifer Kappus, BS, Elias Brandt, and the members of the office staff and physicians of the 12 practices included in this study, as well as the help of Stuart Stoloff, MD, during the training sessions.

References (38)

  • BP Yawn et al.

    Using the ecology model to describe the impact of asthma on patterns of health care

    BMC Pulm Med

    (2005)
  • LC Dowd et al.

    Attitudes of physicians toward objective measures of airway function in asthma

    Am J Med

    (2003)
  • J Walters et al.

    Barriers to the use of spirometry in general practice

    Aust Fam Physician

    (2005)
  • TR Schermer et al.

    Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease

    Thorax

    (2003)
  • TL Petty

    Benefits of and barriers to the widespread use of spirometry

    Curr Opin Pulm Med

    (2005)
  • RA Fried et al.

    The use of objective measures of asthma severity in primary care: a report from ASPN

    J Fam Pract

    (2005)
  • SP Corrigan et al.

    The costs of implementing the 1999 Canadian Asthma Consensus Guidelines recommendation of asthma education and spirometry for the family physician

    Can Respir J

    (2004)
  • Agency for Healthcare Research and Quality

    The Minnesota evidence-based practice center: use of spirometry for case finding, diagnosis, and management of chronic obstructive pulmonary disease (COPD)

  • S Zanconato et al.

    Office spirometry in primary care pediatrics: a pilot study

    Pediatrics

    (2005)
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    Funding was provided by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health: University of Wisconsin at Madison #HL074212-03; Harvard Medical School #HL074227; and University of California at San Francisco #HL074204.

    Dr. Enright is a paid consultant to ndd Medizintechnik AG. The other authors have no conflicts of interest to disclose.

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