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

A Randomized Controlled Trial on Office Spirometry in Asthma and COPD in Standard General PracticeAsthma and COPD are major health problems but are still largely underdiagnosed and undertreated. The role of general practitioners (GPs) is pivotal in the early diagnosis of these diseases, widely recognized as a crucial step in reducing management costs and improving quality of life. Spirometry is the standard method for reaching an accurate diagnosis of asthma and COPD. The use of peak flow meters could be a simple alternative for GPs, but there is no evidence that they can be a reliable tool in the diagnosis of asthma. more

The use of spirometry in general practice has been actively investigated in recent years with conflicting results in the different settings. According to some authors, spirometry in general practice may reduce the underdiagnosis or misdiagnosis, of chronic respiratory disorders. A consensus statement of the National Lung Health Education Program recommends the development, validation, and implementation of office spirometry in the primary care setting. An article on the Differential Diagnosis Between Asthma and COPD study demonstrated that early detection of COPD in general practice is significantly improved by office spirometry.

One peculiarity of the different studies reporting positive results concerning office spirometry is the limited number of GPs involved, and the strict control of the protocol and methodology by specialist personnel. The collaboration in general practice of nonphysicians, such as respiratory nurses and medical undergraduates, seems to render the use of office spirometry more feasible and useful in the diagnosis of COPD. On a larger scale, a study of 33 GPs in Japan and > 1,000 patients showed a good impact of office spirometry in COPD diagnosis.
Technical issues and present levels of standardization, however, do not guarantee as yet the full reliability of office spirometry, despite the easy-to-use and affordable sophisticated devices available today. In countries where efforts to implement office spirometry have been made on a large scale, wide regional variations have been reported in the frequency of utilization and appropriateness., Thiadens et al demonstrated that approximately one half of subjects with a history of persistent cough are affected by asthma or COPD, and most cases can be identified only with history and objective examination.

It is quite obvious that since local health policies, organizations, and resources influence the practice of GPs, the applicability on a large scale of the different protocols described in the literature requires trials for implementation at the local level. The aim of this study was to assess in a very large number of general practices in Italy, the feasibility of office spirometry on a day-by-day basis and, as a primary end point, to verify whether conventional evaluation (history and physical examination) followed by spirometry may be better than conventional evaluation alone in identifying patients with different chronic obstructive airways disorders.

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