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

A Randomized Controlled Trial on Office Spirometry in Asthma and COPD in Standard General Practice: TreatmentThe average time for each visit was 14 ± 5.2 min; the mean time required to instruct patients for spirometry was 5.6 ± 3.1 min; the performance of spirometry took on average 6.4 ± 3.5 min. Mean FEV1 was 83.7 ± 20.9% of predicted, and mean FVC was 91.9 ± 20.4% of predicted. No bronchodilator tests were reported by GPs. Spirometry findings in the normal range were 61.8%; patterns of abnormality were 16.4% for airway obstruction, 12.0% for mixed pattern, and 9.8% for a low FVC without obstruction.
A diagnosis of asthma was made by the GP in 107 patients (32.1%; mean patient age, 42.1 ± 14.6 years; 56.1% female); COPD in 97 patients (29.1%; mean patient age, 59.0 ± 10.3 years; 38.1% female); both asthma and COPD in 8 patients (2.4%; mean patient age, 58.6 ± 14.3 years; 62.5% female); other respiratory disease in 24 patients (7.21%; mean patient age, 47.3 ± 15.1 years; 66.7% female); and no diagnosis in 97 patients (29.1%; mean patient age, 45.8    ± 14.2 years; 55.7% female). The mean spiro-metric values in the asthma group were FEV1 of 87.8    ± 18.8% and FVC of 96.5 ± 17.6% of predicted. A FEV1/FVC ratio < 0.7 was present in 21.0% of patients receiving a diagnosis of asthma. http://antimicrobialmed.com/buy-doxycycline-online.html

In patients receiving a diagnosis of COPD by GPs, mean FEV1 (70.5 ± 19.4% of predicted) and FVC (81.7 ± 22.0% of predicted) were significantly lower than in asthma patients; surprisingly, 30.1% had normal spirometry results. Median time lapse between GP visit and specialist consultation was 10.5 days (mean, 23 days; SD, 34 days; 95% CI, 18.4 to 27.5; data available for 214 patients). To verify the primary end point, the diagnosis registered by the GPs was compared with that made by the reference specialist.
Owing to the presence of random violators and missing diagnosis, an intention-to-treat and a per-protocol analysis along with a power calculation was carried out on the case series at different levels as shown in Table 2. The results show that in any case (all patients, all patients except those with missing diagnosis, only nonrandom violators, only nonrandom violators except those with missing diagnosis), the level of agreement between GPs and specialists did not change significantly whether or not spirometry was used in the GP’s office. The frequency of diagnosis is reported in Table 3, based on the 224 patients who completed the study.

Table 2—Diagnostic Agreement or Disagreement Between GPs and Pulmonary Specialists

Diagnosis Diagnostic Methods, No. (%) Total,No.
IConventional Plus Spirometry IConventional
All patients with complete evaluation!
In agreement 95 (58) 34 (57) 129
Not in agreement 69 (42) 26 (43) 95
Total 164 60 224
All patients except those (n = 44) with missing diagnosis!
In agreement 95 (68) 34 (83) 129
Not in agreement 44 (32) 7(17) 51
>Total 139 41 180
Only nonrandom violators^
In agreement 54 (61) 22 (48) 76
Not in agreement 35 (39) 24 (52) 59
Total 89 46 135
Only nonrandom violators except those with missing diagnosis!
In agreement 54 (69) 22 (79) 76
Not in agreement 24 (31) 6(21) 30
Total 78 28 106

Table 3—Frequency of Diagnosis by GPs and Pulmonary Specialists

Diagnosis by GPs Diagnosis by Pulmonary Specialists
Asthma COPD Asthma Plus COPD Asthma Plus Otherf COPD Plus Otherf Otherf None
Asthma 51! 12 3 13 1 9 1
COPD 10 40| 0 0 6 4 1
Asthma plus COPD 1 3 1! 1 0 0 0
Asthma plus other 1 0 0 0! 0 0 0
COPD plus other 0 2 0 0 1!1! 1 0
Other 3 6 0 4 0 4! 0
No diagnosis 14 16 4 1 0 9 1!1!
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