Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

Abstract

Objective

To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry.

Methods

This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD.

Results

A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers.

Conclusion

Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice.

Keywords:

• chronic obstructive pulmonary disease
• spirometry
• family practice
• primary care physician

Acknowledgements

This article was developed on the basis of the authors’ presentations and discussions at “Overcoming Barriers to COPD Identification and Management”, held in New York, NY, USA, 23–24 March 2009. This meeting, the authors’ participation, and manuscript preparation were supported by Boehringer Ingelheim Pharmaceuticals Inc. and Pfizer Inc. Medical writing assistance was provided by Gill Sperrin CBiol MSB of Envision Scientific Solutions. The article reflects the concepts of the authors and is their sole responsibility. It was not reviewed by Boehringer Ingelheim Pharmaceuticals Inc. or Pfizer Inc., except to ensure medical and safety accuracy.

Disclosures

Tom Barnes has received consultation fees from Boehringer Ingelheim Pharmaceuticals Inc. and Pfizer. Len Fromer has received honoraria for speakers’ bureau from Boehringer Ingelheim Pharmaceuticals Inc. and Pfizer.