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Spirometry in the Primary Care Setting^*

Influence on Clinical Diagnosis and Management of Airflow Obstruction

^* From the Department of Medicine (Dr. Dales), University of Ottawa; and Clinical Epidemiology Unit (Ms. Vandemheem, Ms. Clinch, and Dr. Aaron), Ottawa Health Research Institute, Ottawa, ON, Canada.

Correspondence to: Robert Dales, MD, Division of Respirology, The Ottawa Hospital (General Campus), 501 Smyth Rd, Box 211, Ottawa, ON K1H 8L6, Canada; e-mail: rdales{at}ohri.ca

Study objective: To determine if screening spirometry in the primary care setting influences the physician’s diagnosis and management of obstructive lung disease.

Design: Diagnosis and management assessed before and after the intervention of screening spirometry.

Participants: A total of 1,034 patients who had ever smoked and were at least 35 years of age presenting to primary care practices for any reason.

Setting: Rural primary care practices.

Measurements and results: Physicians were asked prior to and following presentation of spirometry test results if they thought airflow obstruction was present and if they planned to change management based on the results. A new diagnosis of unsuspected airflow obstruction was made by the physician in 93 patients (9%), and a prior diagnosis of airflow obstruction was removed after spirometry in 115 patients (11%). After viewing the spirometry results, physicians reported that they would change patient management in 154 patients (15%). Most planned management changes occurred when airflow obstruction was newly diagnosed (57 of 93 patients, 61%) and when the diagnosis of airflow obstruction remained unchanged (80 of 195 patients, 41%). A 6-month chart review documented the addition of respiratory medications in 8% of patients.

Conclusion: Screening spirometry influences physicians’ diagnosis of airflow obstruction and management plans especially in patients with moderate-to-severe obstruction.

Key Words: asthma • COPD • obstructive lung disease • spirometry

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