Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD.

Chest. 2007 Jun 5
Yawn BP, Enright PL, Lemanske RF, Israel E, Pace W, Wollan P, Boushey H.
Department of Research, Olmsted Medical Center, Rochester, MN.

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

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

Design: A before and after quasi-experimental design. Setting 382 patients from 12 family medicine practices across the U.S. Participants Patients with asthma and COPD and the staff within the 12 practices.

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

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

CONCLUSIONS: U.S. family physicians can perform and interpret spirometry testing for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies and the results of the spirometry tests modify care.




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