The use of clinical signs as a sole guide to assess the severity of respiratory conditions is very limited. This study shows that performing spirometry whenever patients report dyspnea makes a big difference in clinical outcomes.
Approximately 1-4% of primary care office visits are due to dyspnea. However, primary care physicians seldom perform spirometry, therefore, they often overlook chronic pulmonary disease. Proper use of lung function tests can help differentiate between the many causes of dyspnea, monitor the progression of chronic lung disease, and assess response to treatment.
This was clear in a recent cross-sectional evaluation study that was designed with two objectives:
1. To check if the initial impressions of physicians about the severity of their patient´s chronic obstructive pulmonary disease (COPD) correlated with the severity of airflow obstruction measured by spirometry.
2. To evaluate if spirometry results changed the physicians´ opinion about the severity of the disease and the treatment.
Method
The investigators conducted this cross-section, multicenter study in 83 primary care facilities across the USA. A total of 899 patients with the clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD) participated: they completed a questionnaire and underwent spirometry testing. On the other hand, physicians delivered a questionnaire and case report forms. Then, researchers assessed concordance between patients and physicians impressions and spirometry results.
Without spirometry, Chronic Obstructive Pulmonary Disease is overlooked
Without spirometry, Chronic Obstructive Pulmonary Disease is overlooked
The results showed that primary care physicians underestimated the severity of COPD in 41% of patients while overestimating it in 29% of them when comparing their clinical assessment with spirometry performed immediately in the office. In general, the estimated severity was correct in 30% of patients.
In fact, spirometry changed the physicians' initial diagnosis and treatments for approximately one-third of those patients. This proves that performing spirometry in primary care, plays a very important role in the early detection and treatment of Chronic Obstructive Pulmonary Disease.
