Chest
ORIGINAL RESEARCHASTHMASpirometry Can Be Done in Family Physicians' Offices and Alters Clinical Decisions in Management of Asthma and COPD
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)
- et al.
Controversies in the use of spirometry for early recognition and diagnosis of chronic obstructive pulmonary disease in smokers
Clin Chest
(2000) - et al.
Spirometry in primary care practice: the importance of quality assurance and the impact of spirometry workshops
Chest
(1999) The role of measuring FEV1in determining therapeutic changes made in an asthma clinic in general practice
Respir Med
(1995)- et al.
Attaining a correct diagnosis of COPD in general practice
Respir Med
(2005) - et al.
Underuse of spirometry in primary care [letter]
Chest
(2004) - et al.
Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study
Chest
(2004) - et al.
Spirometry in the primary care setting: influence on clinical diagnosis and management of airflow obstruction
Chest
(2005) - et al.
Impact of spirometry on GPs' diagnostic differentiation and decision-making
Respir Med
(2004) - et al.
Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program
Chest
(2000) - et al.
Quality of spirometry test performance in children and adolescents: experience in a large field study
Chest
(2000)
Using the ecology model to describe the impact of asthma on patterns of health care
BMC Pulm Med
Attitudes of physicians toward objective measures of airway function in asthma
Am J Med
Barriers to the use of spirometry in general practice
Aust Fam Physician
Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease
Thorax
Benefits of and barriers to the widespread use of spirometry
Curr Opin Pulm Med
The use of objective measures of asthma severity in primary care: a report from ASPN
J Fam Pract
The costs of implementing the 1999 Canadian Asthma Consensus Guidelines recommendation of asthma education and spirometry for the family physician
Can Respir J
The Minnesota evidence-based practice center: use of spirometry for case finding, diagnosis, and management of chronic obstructive pulmonary disease (COPD)
Office spirometry in primary care pediatrics: a pilot study
Pediatrics
Cited by (0)
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.