A Randomized Controlled Trial on Office Spirometry in Asthma and COPD in Standard General Practice: Definition

The analysis of the different items in patient records showed that history data in some way supported diagnosis in 16.4% of patients with regard to occupational exposure; 37.8% with regard to familiarity for asthma, COPD, or allergy; and 13.3% and 10.2% with regard to previous diagnosis of seasonal or perennial allergy, respectively. Allergy was more frequently registered in asthma patients than in other groups, as expected (21.5% had seasonal and 13.1% had perennial allergy). The frequency of the different risk factors was not significantly different between the two arms of the randomized study. The comparison of respiratory symptoms showed a noteworthy difference between asthma and COPD only for expectoration and chest tightness (Table 4). As for comorbidities relevant to lung chronic obstructive disorders, the most prevalent were rhinitis (24.9% of all patients, 40.2% of asthma patients, 4.1% of COPD patients), sinusitis (9.8%, no significant difference between asthma and COPD), and gastroesophageal reflux (15.1% of patients, 17.5% with COPD vs 8.4% with asthma).
Physical examination of the thorax was normal in 33.8% of patients. Wheezes, ronchi, rales, and crackles were reported in 46.2%, 18.7%, 6.2%, and 6.2% of cases, respectively, without significant differences between the two intervention arms. Normal findings were more common in asthma (33.6%) than in COPD (11.3%) patients. so

In the global patient population, significant ORs (p = 0.02 at least) for diagnostic positive predictive power were found for age > 65 years (OR, 5.65; CI, 2.1 to 15.2), smoking (OR, 5.0; CI, 2.4 to 10.4), and dyspnea (OR, 2.3; CI, 1.1 to 4.6) in the case of COPD. In the differentiation of asthma from COPD, only wheezing (OR, 2.9; CI, 1.6 to 5.4) and allergy (OR, 3.2; CI, 1.6 to 6.6) made a significant positive contribution (p = 0.001 at least).
Considering only patients with concordant diagnosis between GP and specialist, age > 65 years, smoking, and occupational exposure oriented toward COPD with ORs of 11.6 (CI, 1.2 to 113.0), 16.6 (CI, 3.7    to 74.8), and 10.1 (CI, 1.4 to 72.3), respectively (p = 0.03 at least). Allergy and wheezing oriented toward asthma with ORs of 13.0 (CI, 1.7 to 99.2) and 8.7    (CI, 1.9 to 38.7), respectively (p = 0.01 at least).

Table 4—History of Respiratory Symptoms at Enrollment

Symptoms GlobalPopulation Labeled as COPD Labeled as Asthma
Cough 76 81.4 74.8
Expectoration 37.3 63.9 22.4
Dyspnea 46.7 49.5 45.8
Wheezing 44 43.3 49.5
Chest tightness 27.1 20.6 32.7
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