The necessity for spirometry in the primary care management of COPD

Abstract

KEYWORDSSummary Implementation of spirometry in the primary care setting is controversial. Spirometry allows a unique non-invasive look into the functioning of the lungs, which can be both medically informative and of practical value. Respiratory complaints are among the most prevalent in primary care, while smoking rates remain globally high, illustrating the need for proper tools to investigate the possible causes of chronic pulmonary symptoms. Smoking cessation programs and disease management programs are the preferred treatment strategies for COPD; these rely on a valid spirometric diagnosis, as promoted by international COPD guidelines. In addition, involving the patient in treatment plans and explaining the detrimental effects of smoking can be greatly facilitated by the visual impact of a flow-volume curve, have promoted the use of spirometry. While there are difficulties in implementation of spirometry in primary care. Provided that quality standards of performance and training are sufficiently met, evidence suggests that spirometry is a valid, feasible and interpretable diagnostic tool in a primary care setting. COPD is a growing problem for society, which should not be underestimated, and with sufficient funding, adequate training and motivated healthcare workers, there is no good reason why spirometric testing cannot be widely implemented. © 2003 General Practice Airways Group. Published by Elsevier Ltd. All rights reserved.Over the past few years, increasing attention has been paid to the detection and treatment of chronic obstructive pulmonary disease (COPD) in primary care, in part caused by the worldwide increase in burden and mortality [1]. In contrast with other major diseases, the prevalence of COPD will continue to rise, predominantly caused by an increase in the numbers of female patients with COPD [2]. Early diagnosis of COPD is important, since smoking cessation can reduce the rate of progression to severe disease [3], which benefits each patient and every practice. There are, however, both patient-and healthcare provider-related factors which hamper * Tel.: +31-43-3882315; fax: +31-43-3619344.E-mail address: niels.chavannes@hag.unimaas.nl (N. Chavannes). this early detection [4], in particular underreporting of complaints and lack of active detection.Spirometry is being increasingly implemented throughout primary care in Western Europe, and in some countries is now being used in the majority of practices [5,6]. GPs seem to appreciate this relatively new tool highly [7], as it generates diagnostic information previously unattainable in primary care. It provides a comprehensive overview of airflow and lung capacity, and with high quality measurement, permits an accurate and reliable diagnosis of obstructive airways disease and the degree of reversibility. A recent study has shown for the first time that performing simple spirometric tests in the primary care setting produces results at least as good as those of pulmonary function laboratories [8]. Recognizing patterns of obstruction,

What's in this issue?

“…In previous issues of the PCRJ we have published various papers relating to the difficulties encountered in general practice when performing spirometry or in accessing spirometry services [9][10][11][12]. When performing a spirometry manoeuvre, patients with COPD often need to exhale for longer than 6 seconds in order to achieve their forced vital capacity (FVC), i.e., to achieve a flat volume-time plateau.…”

What's in this issue?

“…The accuracy of spirometry testing and the need for its interpretation in primary care has been the subject of a number of papers published in this journal over the last year [9][10][11][12][13][14][15]. Indeed, the debate continues with the letter by White in this issue [16].…”

FEV1 or peak flow for measuring airflow obstruction in primary care Is it a usefuldebate or just missing the point?

“…There are however some major deficiencies in using peak flow measurements in COPD compared to FEV 1 . Firstly very little is known about the longitudinal behaviour of peak flow in COPD and it does not compare to epidemiological and prognostic value of FEV 1 . Peak flow has not been used to stage COPD in any of the guidelines or statements but like FEV 1 also offers no explanation of the cause of the airway obstruction.…”

“…There is a significant difference in complexity between the simple measurement of FEV 1 and the derivation and interpretation of flow-volume curves. The additional diagnostic value of the flow-volume curve is promoted by Chavannes as an advantage of spirometry [1]. However the distinction between this and the simple measure of FEV 1 is overlooked.…”