Difficulties in the Interpretation of Lung Function Tests in the Diagnosis of Asthma and Chronic Obstructive Pulmonary Disease

Raghunath, A. S.; Innes, Andrew; Norfolk, Linda; Hannant, Maureen; Greene, Tim; Greenstone, M A; Morice, Alyn H.

doi:10.1080/02770900600925221

Cited by 11 publications

(12 citation statements)

References 6 publications

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“…A study by Raghunath et al [33] indicated that there are significant differences in the interpretation of spirometry data between GPs and specialists. Marklund et al [34] examined adults with a diagnosis of asthma from 2 general practices, where in only 60% of patients was this diagnosis confirmed by specialist examination.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis in a Primary Care Population with Presumed Airway Obstruction: A Real-Life Study

et al. 2011

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Background: Asthma and chronic obstructive pulmonary disease (COPD) have major symptoms in common. However, the mode of the underlying chronic airway inflammation is different. There is still no single diagnostic test that can be considered a gold standard to distinguish asthma from COPD. Objectives: To determine the diagnostic accuracy for asthma and COPD of a series of diagnostic steps in a population older than 40 years with probable obstructive airway disease (OAD) in primary care. Methods: In this prospective cohort study, patients without a certain diagnosis underwent a work-up, including office spirometry by their general practitioner (GP). They were then referred to a pulmonologist, and they had control visits with their GP. The diagnostic gain of subsequent steps was calculated for 2 endpoints, namely the specialist’s opinion and the GP’s final opinion. Results: Up to 60% of the patients failed to consult with the pulmonologist. For this subgroup, the office spirometry induced significantly more diagnostic congruency than any other diagnostic step. The specialists rejected 44.5% of the diagnoses made by the GPs, including spirometry. High values of diagnostic gain were found after the office spirometry and after the specialist’s advice. Up to 25% of the population taking bronchodilators were judged not to suffer from OAD. Conclusions: Office spirometry added significantly more to the diagnostic certainty of the GPs than questionnaires, history and clinical examination. A pulmonologist’s advice contributed more to diagnostic certainty than any other diagnostic step. Nevertheless, 26% of the diagnoses made by the chest physicians were reconsidered by the GPs.

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Section: Discussionmentioning

confidence: 99%

Differential Diagnosis in a Primary Care Population with Presumed Airway Obstruction: A Real-Life Study

et al. 2011

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“…Results of the present study concur with the results of EATON et al [5] and show that, generally, GPs have made progress in the interpretation of test results relevant for respiratory diseases in primary care. The current acuity of GPs' interpretation of test results should weaken earlier reported lack of confidence in the ability to interpret the test results [8,9].…”

Section: Spirometry Expert Support and Gps Pjp Poels Et Almentioning

confidence: 99%

“…In 1999, EATON et al [5] had already found that 53% of GPs' interpretation of spirometry test results was judged to be correct according to an expert panel. Recently, RAGHUNATH et al [9] found that the agreement in interpretation of spirometry and peak flow results between nurses, GPs and an expert panel was only 20%. The lower agreement in the latter study could probably be explained by the fact that GPs, as well as nurses, i.e.…”

Section: Spirometry Expert Support and Gps Pjp Poels Et Almentioning

confidence: 99%

“…Most common barriers that impede utilisation of spirometry in general practice are: the absence of properly trained staff [5]; the lack of time and practice support to fit spirometry into the daily practice routine [6]; the absence of a spirometer in the practice [7]; and GPs' lack of confidence in the ability to interpret the test results [8,9]. A recent survey [4] showed that one third of Australian GPs interpreted less than one spirometry test per week.…”

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confidence: 99%

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Impact of a spirometry expert system on general practitioners' decision making

Poels¹,

Schermer²,

Schellekens³

et al. 2008

European Respiratory Journal

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The present study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs' decision making in diagnosing chronic respiratory disease.A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Intervention consisted of support for GPs' spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs' diagnoses was compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were: additional diagnostic test rates; width of differential diagnosis; certainty of diagnosis; estimated severity of disease; referral rate; and medication or nonmedication changes. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).There were no differences between the expert support and control groups in the agreement between GPs and expert panel diagnosis of chronic obstructive pulmonary disease (OR (95% CI) 1.08 (0.70-1.66)), asthma (1.13 (0.70-1.80)), and absence of respiratory disease (1.32 (0.61-2.86)). A higher rate of additional diagnostic tests was observed in the expert support group (2.5 (1.17-5.35)).Computerised spirometry expert support had no detectable benefit on general practitioners' diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease.

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“…2) What is the effect of spirometry on a primary-care physician's certainty about a diagnosis, and what are the consequences in terms of ordering of additional diagnostic tests and referrals to specialists? 3) How can we support primary-care physicians with their interpretation of spirometry tests, which is often not as adequate as secondary-care respiratory specialists would like to see [7,8]? Only with well-designed studies that address these questions can we really move the research on the value of spirometry for primary-care physicians and their patients forward.…”

mentioning

confidence: 99%

Effect of spirometry on COPD management in primary care: where are the studies that we really need?

Poels¹,

Schellekens²,

Schermer³

2007

European Respiratory Journal

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Difficulties in the Interpretation of Lung Function Tests in the Diagnosis of Asthma and Chronic Obstructive Pulmonary Disease

Abstract: This study raises concerns about differences in the interpretation of spirometry and peak expiratory flow rates in general and hospital practice and the guidelines on which these interpretations are based.

Cited by 11 publications

References 6 publications

Differential Diagnosis in a Primary Care Population with Presumed Airway Obstruction: A Real-Life Study

Differential Diagnosis in a Primary Care Population with Presumed Airway Obstruction: A Real-Life Study

Impact of a spirometry expert system on general practitioners' decision making

Effect of spirometry on COPD management in primary care: where are the studies that we really need?

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