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* From the Departments of General Practice (Drs. Buffels, Degryse, and Heyrman) and Pulmonology (Dr. Decramer), Katholieke Universiteit, Leuven, Belgium.
Correspondence to: Johan Buffels, MD, Academisch Centrum voor Huisartsgeneeskunde Kapucijnenvoer 33 Blok J B-3000 Leuven, Belgium; e-mail: johan.buffels{at}coditel.net
Study objectives: To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire.
Methods: A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards.
Results: The positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood ratio, 2.6). One hundred twenty-six cases of formerly unknown OLD were detected in the group of patients with complaints, vs an extrapolated number of 90 in the group without complaints. Despite a negative predictive value of 95% for the questionnaire used, 42% of the newly diagnosed cases of OLD would not have been detected without spirometry.
Conclusions: The use of a spirometer is mandatory if early stages of OLD are to be detected in general practice. Screening for airflow obstruction almost doubles the number of known patients with OLD.
Key Words: asthma • COPD • diagnosis • family practice • spirometry
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