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At least 19 recordsLinked to original sources
PubMed1999

Spirometry in primary care practice: the importance of quality assurance and the impact of spirometry workshops.

OBJECTIVE: To determine the quality of spirometry performed in primary care practice and to assess the impact of formal training. DESIGN: Randomized, controlled prospective interventional study. SETTING: Primary care practice, Auckland City, New Zealand. PARTICIPANTS: Thirty randomly selected primary care practices randomized to "trained" or "usual" groups. One doctor and one practice nurse were nominated to participate from each practice. INTERVENTIONS: "Trained" was defined as participation in an "initial" spirometry workshop at week 0 and a "maintenance of standards" workshop at week 12. "Usual" was defined as no formal training until week 12, when participants they attended the same "initial" workshop provided for the trained group. The study duration was 16 weeks. Each practice was provided with a spirometer to be used at their clinical discretion. MEASUREMENTS AND RESULTS: Spirometry data were uploaded weekly and analyzed using American Thoracic Society (ATS) criteria for acceptability and reproducibility. The workshops were assessed objectively with practical and written assessments, confirming a significant training effect. However, analysis of spirometry performed in clinical practice by the trained practitioners revealed three acceptable blows in only 18.9% of patient tests. In comparison, 5.1% of patient tests performed by the usual practitioners had three acceptable blows (p<0.0001). Only 13.5% of patient tests in the trained group and 3.4% in the usual group (p<0.0001) satisfied full acceptability and reproducibility criteria. However, 33.1% and 12.5% of patient tests in the trained and usual groups, respectively (p<0.0001), achieved at least two acceptable blows, the minimum requirement. Nonacceptability was largely ascribable to failure to satisfy end-of-test criteria; a blow of at least 6 s. Visual inspection of the results of these blows as registered on the spirometer for the presence of a plateau on the volume-time curve suggests that < 15% were acceptable. CONCLUSIONS: Although a significant training effect was demonstrated, the quality of the spirometry performed in clinical practice did not generally satisfy full ATS criteria for acceptability and reproducibility. Further study would be required to determine the clinical impact. However, the ATS guidelines allow for the use of data from unacceptable or nonreproducible maneuvers at the discretion of the interpreter. Since most of the failures were end-of-test related, the FEV1 levels are likely to be valid. Our results serve to emphasize the importance of effective training and quality assurance programs to the provision of successful spirometry in primary care practice.

Adolescent↗
PubMed2006

A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from spirometry in Asthma and COPD: a comparative evaluation Italian study.

STUDY OBJECTIVES: To evaluate whether office spirometry by general practitioners (GPs) is feasible and may improve the diagnosis of asthma and COPD. METHODS: A prospective, randomized, comparative trial was planned involving 57 Italian pulmonology centers and 570 GPs who had to enroll consecutive subjects aged 18 to 65 years with symptoms of asthma or COPD without a previous diagnosis. Patients were randomized 1:1 into two groups with an interactive voice responding system: conventional evaluation alone vs conventional evaluation and spirometry. Office spirometry was performed by GPs who were trained by reference specialists using a portable electronic spirometer (Spirobank Office; MIR; Rome, Italy). Diagnosis was confirmed by the reference specialist center in blind fashion. RESULTS: Seventy-four GPs complied to the trial. Of 333 patients enrolled, 136 nonrandom violators completed the protocol. Per-protocol analysis showed a concordant diagnosis between GPs and specialists in 78.6% of cases in the conventional evaluation-plus-spirometry group vs 69.2% in the conventional evaluation group (p = 0.35). In the intention-to-treat analysis, the respective percentages of concordant diagnosis were 57.9 and 56.7 (p = 0.87). CONCLUSIONS: Office spirometry by GPs is feasible, but frequent protocol violation and inadequate sample size did not allow us to prove a significant advantage of office spirometry in improving the diagnosis of asthma and COPD in standard general practice as organized at present in Italy, thus reinforcing the need for close cooperation between GPs and specialists in respiratory medicine.

Adult↗
PubMed1996

Spirometry of healthy adult South African men. Part II. Interrelationship between socio-environmental factors and 'race' as determinants of spirometry.

AIM: To examine the interaction of socio-environmental background, 'race' and anthropometry on spirometry. METHODS: A study population of white and black bank workers with broadly comparable current socio-economic circumstances was identified. Detailed questionnaires regarding a number of indicators of socio-environmental status (SES) were administered in addition to anthropometric and spirometric measurements. Multiple linear regression analyses were performed. The Kappa statistic was used to determine the best predictors of SES. RESULTS: 'Race' was found to be the best predictor of SES. Within the black group a sub-classification of high and low SES was possible. In all respects the white SES indicators were higher than those of the black high SES group. Multiple regression analysis showed that sitting height was a better anthropometric predictor of spirometry than standing height. Replacing 'race' with other indicators of SES gave similar measures of prediction (by Mallow's CP statistic) of spirometry in the over-30-year age group. CONCLUSION: The impact of 'race' on spirometry can be reduced substantially by incorporating sitting height and indicators of SES in the regression equations. This observation lends support to the hypothesis that 'race' is not a direct genetic predictor of lung size, but may have an influence because of SES and anthropometric features associated with 'race'.

Adult↗
PubMedDate not supplied

Value of spirometry in detecting volume restriction in interstitial lung disease patients. Spirometry in interstitial lung diseases.

BACKGROUND: Restriction is a typical functional abnormality in interstitial lung disease (ILD) patients, but is not always present, especially in the early stage of the disease. The greater reduction of vital capacity (VC; %pred.) than total lung capacity (TLC; %pred.) is regarded as a typical pattern of lung function disturbances in ILD patients. STUDY OBJECTIVES: To explore the diagnostic value of spirometry in a detection restrictive pattern the relative volume loss assessed by TLC and VC in large series of patients with a diagnosis of ILD referred for lung function tests was evaluated. METHODS: Retrospective, cross-sectional analysis of pulmonary function data was done. The sampleconsisted of 1,173 patients with the diagnosis of different interstitial lung diseases investigated during a period of 5 years. Only patients without airway obstruction (normal FEV1%VC) were included. In all cases spirometry and whole body plethysmography were performed by experienced staff using MasterLab - 'Jaeger' equipment according to ERS standards. Reference values according to ERS guidelines were applied. RESULTS: The mean value of TLC expressed as %pred. was significantly (p < 0.001) lower than VC in all patients (93.7 +/- 18.6 vs. 98.0 +/- 21.4%pred.). The frequency of abnormal (lowered) TLC results was also higher than lowered VC (22.8 vs. 17.8%). Sensitivity of VC reached 69.3% and the positive predictive value was 88.5% in detecting volume restriction as compared to TLC measurement. CONCLUSION: The relative loss of TLC was greater than VC in our large group of patients. Measurement of TLC should be part of functional assessment of ILD patients, irrespective of whether they present or do not present a restrictive pattern in spirometry.

Adolescent↗
PubMedDate not supplied

Don't just "do spirometry"--closing the loop in workplace spirometry programs.

The authors acknowledge that surveillance is a word that often causes eyes to glaze over and recognize that spirometry is often a casualty of a routine approach to surveillance. This article describes how to use spirometry as an active part of an on-site workplace occupational health program whose emphasis is avoiding trouble by knowing where and how to look for signs of occupational lung disease.

Humans↗
PubMedDate not supplied

Clinical validation of automated spirometry used in surveys of large occupational groups: comparison with conventional water spirometry.

An accurate, rugged automated spirometer which provides immediate data is useful both clinically and for screening large groups with various environmental exposures. Because the need for such surveys has been increasing, we compared a computerized mass flow-meter with a conventional water spirometer. The same forced expiration was measured by both instruments in the laboratory and during an occupational survey. Mean values for forced vital capacity (FVC) were 96 cc greater by the automated technique in the laboratory (this equals 2.2% of the value by the conventional method, with a correlation, r, of 0.998) and 97 cc greater in the field (2.3% of the conventional method; r = 0.995). Differences between the two methods in the laboratory and field for forced expiratory volume in one second (FEV 1.0) were +24 cc (0.68%; r = 0.996) and +47 cc (1.6%; r = 0.996) and for forced expiratory flow (FEF)25-75--179cc/sec (4.18%; r = 0.968) and -63 cc/sec (2.1%; r = 0.992), respectively. For FVC and FEV1.0, the differences between paired values were less than or equal to 10% of the value by water spirometry in all instances and less than or equal to 5% in 95.5% and 96% of comparisons, respectively. For FEF 25-75 the differences between paired values were less than or equal to 20% in 97.2% and less than or equal to 10% in 84.7% of comparisons. These findings confirm the validity of the measurements provided by the automated spirometer.

Autoanalysis↗
PubMedDate not supplied

Spirometry and obstructive lung disease in Manitoba.

BACKGROUND: Spirometry, the measurement of forced expiratory volume in 1 s and forced vital capacity, is recommended in the diagnosis and management of the obstructive lung diseases asthma and chronic obstructive pulmonary disease (COPD). The present report describes spirometry use in Manitoba and tests the hypothesis that regional spirometry use correlates with the prevalence of physician-diagnosed obstructive lung diseases. METHODS: Spirometry is renumerated on a fee-for-service basis by Manitoba Health. Like other physician services, billing data include a diagnosis, patient identifiers, as well as the patient's sex, date of birth and residential postal code. Physician billings for spirometry for 1991 to 1998 were analyzed, comparing data with billings for physician visits for obstructive diseases. Four age groups were examined, as were income quintiles in Winnipeg, Manitoba. In addition, the prevalence of physician-diagnosed obstructive diseases were compared with spirometry rates in 49 service use areas of the province. RESULTS: Annually, about 3% of the Manitoba population underwent spirometry, and in aggregate, about 14% underwent spirometry during the eight years of the study. Rates in Winnipeg were higher than in the remainder of the province. Spirometry rates did not increase with time, and people who underwent spirometry had 1.4 to 1.7 tests/year. In children, higher income quintiles were tested more than lower income quintiles, while in adults, income quintiles were tested with equal frequency. People with obstructive lung disease accounted for about 75% of those tested, and in people with these diagnoses, the likelihood of testing increased approximately linearly with the number of physician visits for asthma or COPD. Children with asthma were tested less often than adults, and adults with asthma or both asthma and COPD were tested more often than those with COPD alone. In adults with asthma or asthma and COPD who had more than 10 physician visits for these diagnoses, testing rates were more than 70%, and multiple tests were common. In patients labelled with COPD only and with more than 20 physician visits, about one-third did not undergo spirometry. In children aged five to 14 years and in adults 15 to 44 years old, regional spirometry rates correlated well with regional asthma rates. Regional spirometry rates also correlated significantly with regional rates of asthma and/or COPD in people older than 34 years old. INTERPRETATION: Spirometry use is considerably higher in patients with asthma than in patients with COPD, suggesting that guidelines are followed more closely in patients with asthma, and that many patients are labelled with COPD without appropriate documentation. Spirometry use is apparently indicative of physician interest in the problem of obstructive lung diseases.

Adolescent↗
PubMed2006

Outcomes associated with spirometry for pediatric asthma in a managed care organization.

BACKGROUND: The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing "at least every 1 to 2 years to assess the maintenance of airway function." OBJECTIVE: The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma. METHODS: We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003). We included all of the continuously enrolled patients with active asthma between 7 and 21 years of age. Our outcomes of interest were the presence of > or = 1 claim for spirometry testing (Common Procedural Terminology 94010-6, 94060, 94070, or 94150) and the time to emergency department visit. We used multivariate logistic regression to determine factors associated with receipt of spirometry and survival analyses techniques to assess the association between receipt of spirometry with the likelihood of an emergency department asthma visit in the next year, controlling for patient age, gender, severity of illness, and type of insurance. RESULTS: There were 2688 eligible children of whom 1509 (56%) were male, 324 (12%) had Medicaid insurance, and 624 (24%) had persistent asthma in the initial year. Of the 2688 children, only 612 (23%) had > or = 1 claim for spirometry testing during the study period. In all of the multivariate logistic analysis models, increased severity of illness was consistently associated with increased likelihood of receiving spirometry testing. Compared with patients without Medicaid insurance, children with Medicaid insurance were consistently less likely to receive spirometry testing. After adjusting for age, gender, severity, and insurance type, receipt of spirometry did not affect the likelihood of future emergency department asthma use. CONCLUSIONS: Children with Medicaid insurance are less likely to receive spirometry testing. Reasons may be because of access to care, inadequate provider referral for testing, or patient preferences. Objective lung function tests, such as spirometry, are a potentially important component of monitoring chronic disease status. However, it is not clear whether spirometry testing by itself, completed every 1 to 2 years, helps prevent the likelihood of emergency department asthma visits. Compared with guideline recommendations, spirometry is underused; however, additional work is needed to understand how to best integrate such testing to improve asthma outcomes.

Adolescent↗
PubMed2004

[Spirometry in a health care center: indications, results and quality.].

OBJECTIVE: Spirometry is important for the diagnosis and treatment of lung diseases. Studies on the use of spirometry in health care centers are few and none in Iceland. The objective of this study was to evaluate the use of spirometry in a single health care center in Iceland in regard to indications, quality and results. MATERIALS AND METHODS: Patients evaluated at the Primary Care Clinic in Garethabaer during a 6 month period were included in the study. Information was collected about the spirometry, indications and treatment given. Spirometry was done by a physican or nurse. All spirometries were evaluated by a pulmonary specialist. The study was approved by the National bioethics committee and Data protection agency. RESULTS: During the study period 63 spirometries were done and majority of them were on the request of one physican. There were 19 males and 44 females and the age distribution was from 17 to 69 years of age. Smokers were 17/63, former smokers were 24 and 20 were non smokers. The most common indication for spirometry was cough in 37/63 and dyspnea in 20/63. No spirometry was done for history of smoking only. Twenty eight patients had abnormal lung auscultation. The quality of the spirometry was sufficient in 54/63. In 24/63 patients the spirometry was normal. Of those with abnormal spirometry 30 had obstruction, 3 had restriction and in 6/63 of cases the results were mixed. CONCLUSION: The study indicates that primary care physicians are underutilizing spirometry for diagnosis of lung diseases.

English Abstract↗
PubMed2006

Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.

OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a spirometry evaluation programme in the Netherlands. All practices owned a spirometer and were trained to perform spirometry. SUBJECTS: A total of 144 general practitioners and 179 practice assistants. MAIN OUTCOME MEASURES: Extent of spirometry utilization for five indications from national COPD/asthma guidelines, practitioner and practice-related factors associated with spirometry utilization. RESULTS: The response rate was 97%. General practitioners used spirometry mostly to evaluate treatment with inhaled steroids (58%). Significant practitioner-related factors associated with spirometry utilization were: general practitioners' job satisfaction, general practitioners' general interest in research, and prior participation in spirometry training. Practice-related factors associated with spirometry utilization were: presence of a practice nurse, delegation of medical tasks to practice assistants, use of spirometry in different rooms, and use of protocols in practice. CONCLUSION: Practitioner- as well as practice-related factors were associated with the extent of spirometry utilization. In particular, it is essential to improve practice-related factors (e.g. presence of a practice nurse, more delegation of medical tasks to the practice assistant).

Adult↗
PubMed2005

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians.

BACKGROUND: The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established. METHODS: To assess primary care physicians' knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease, we conducted a brief mail survey on the local practice of office spirometry, barriers to performing office spirometry, and general knowledge about spirometry. We also provided 60-min educational workshops to assess whether such an approach would increase spirometry testing or perceptions about spirometry. RESULTS: Twenty-nine of 57 (51%) primary care offices responded to the survey. Of these, 66% owned their own spirometer. The most common reasons for not performing spirometry were uncertainty about the impact of the test (41%), physician and staff unfamiliarity (38%), and lack of training (34%). Twenty-one respondents participated in the workshops. In the 3 months following the workshops, the number of spirometry tests increased by 59% (p = 0.004). After the workshops, the proportion of clinics that reported reasons for not performing the test decreased by 13% (p = 0.01), but important barriers to performing office spirometry were still present, including physician and staff unfamiliarity (22%), uncertain interpretation of results (22%), time (22%), and reimbursement (22%). CONCLUSIONS: The general knowledge and use of office spirometry in the primary care community is poor, but can be improved, at least in the short-term, by a simple educational workshop.

Clinical Competence↗
PubMed2006

[Spirometry in primary care in Navarre, Spain].

OBJECTIVE: To analyze the use and quality of spirometry in primary care settings in Navarre, Spain. PATIENTS AND METHODS: A questionnaire was completed simultaneously by professionals responsible for spirometry in all of the primary health care centers in Navarre. Data were collected on availability, model of spirometer, frequency of use, calibration, methods, personnel responsible for testing, and training of personnel. Then, baseline spirometry without a bronchodilator test was performed in 171 patients in their primary health care center and then the test was repeated on the same day in a hospital pneumology department. Spirometry was supervised by 2 pneumologists who jointly assessed the acceptability of the flow-volume curves. The quality of spirometry was assessed according to the recommendations of the American Thoracic Society and the interpretation of spirometry results according to the criteria of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). RESULTS: A total of 90.9% of primary health care centers in Navarre have a spirometer, although 22% of those spirometers have never been used. Only 2 centers performed between 10 and 20 spirometry tests per week and none performed more than 20. In 96% of primary health care centers the spirometers were not regularly calibrated. The professionals who performed spirometry were not dedicated for that task in 51.2% of cases, and the mean period of supervised training was 10 hours. When comparisons were made between the mean values obtained in the primary care centers and the pneumology department, statistically significant differences were detected for forced vital capacity (P < .0001) and forced expiratory volume in the first second (P = .0002). Significant differences were also found between the flow-volume curves performed in the 2 different care settings for the initial and end portions of the curve as well as for the slope. The criteria for reproducibility recommended by the American Thoracic Society were not met in 76% of cases for forced vital capacity and 39.7% of cases for forced expiratory volume in the first second. Incorrect functional diagnosis occurred in 39.7% of spirometry tests and there was a tendency in the primary care settings to falsely diagnose patterns as restrictive and to inadequately classify the severity of obstruction. CONCLUSIONS: Despite the fact that spirometers are available in the majority of primary health care centers in Navarre, we found a marked underuse of these devices and little compliance with recommendations for the use of spirometry. Furthermore, the quality of the measurements performed in this care setting was very low.

Adult↗
PubMed2005

Use of spirometry and respiratory drugs in Manitobans over 35 years of age with obstructive lung diseases.

BACKGROUND: Previous data indicated that spirometry was underused in people with obstructive disease, especially those with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To examine the use of respiratory drugs in patients with COPD and asthma, and to relate drug use to spirometry. METHODS: Manitoba Health maintains a database of physician services remunerated by fees that includes spirometry. The database contains the diagnosis and patient identifiers, as well as sex, date of birth and residential postal code. Similar identifiers are used in the provincial pharmacare program that records prescriptions dispensed at retail pharmacies. These databases were examined for the time period between 1996 to 2000, and people over 35 years of age diagnosed with asthma, COPD or both were identified. The frequency of spirometry in these patients and their use of respiratory drugs was determined. RESULTS: Spirometry and drug prescription frequencies increased with the number of physician visits (including those for bronchitis), but their patterns differed. Patients with asthma or asthma plus COPD had considerably higher rates of drug prescription and slightly higher spirometry rates than did those with COPD. Patients with asthma and asthma plus COPD who underwent spirometry were slightly more likely to receive drugs than those who did not undergo spirometry; this trend was more striking in patients with COPD. However, approximately 30% of patients with COPD who had five physician visits and who underwent spirometry did not receive drugs; this was true for approximately 10% of similar patients with asthma. Patients with asthma generally received beta-agonists and inhaled steroids; these agents were less commonly given to patients with COPD, who instead were given anticholinergics much more often than were asthmatics. Patients who were diagnosed with asthma plus COPD had beta-agonist and inhaled corticosteroid prescription rates similar to asthmatics, and anticholinergic prescription rates similar to patients with COPD. Theophylline and antileukotriene drugs were used less often than were inhaled agents. In patients with asthma, drugs were frequently discontinued, and during drug use, prescription refills were consistent with an intake of 30.9% of the prescribed doses. In patients with COPD, discontinuing drugs early was uncommon, and refills were consistent with the use of 54% of the prescribed amounts. The same was true of patients with both COPD and asthma. DISCUSSION: Drug prescription was considerably more common in patients labelled with asthma or COPD plus asthma than in patients with COPD. Spirometry was also less common in patients with COPD but had a distinct influence on the frequency of drug prescription. Patterns of drug prescription were predictable, and patterns of drug use indicated poor compliance, in agreement with other data. The results suggest that COPD symptoms may be discounted and patients systematically undertreated or the diagnosis could frequently be applied to people with trivial disease or both.

Adrenergic beta-Agonists↗
PubMed1999

How accurate is spirometry at predicting restrictive pulmonary impairment?

OBJECTIVE: To determine the accuracy with which spirometric measurements of FVC and expiratory flow rates can diagnose the presence of a restrictive impairment. DESIGN: The pulmonary function tests of 1,831 consecutive white adult patients who had undergone both spirometry and lung volume measurements on the same visit over a 2-year period were analyzed. The probability of restrictive pulmonary impairment, defined as a reduced total lung capacity (TLC) below the lower limit of the 95% confidence interval, was determined for each of several categoric classifications of the spirometric data, and additionally for each of several interval levels of the FVC and the FEV1/FVC ratio. SETTING: A large clinical laboratory in a university teaching hospital using quality-assured and standardized spirometry and lung volume measurement techniques according to American Thoracic Society standards. RESULTS: Two hundred twenty-five of 1,831 patients (12.3%) had a restrictive defect. The positive predictive value of spirometry for predicting restriction was relatively low; of 470 patients with a low FVC on spirometry, only 41% had restriction confirmed on lung volume measurements. When the analysis was confined to the 264 patients with a restrictive pattern on spirometry (ie, low FVC and normal or above normal FEV1/FVC ratio), the positive predictive value was 58%. Conversely, spirometry had a very favorable negative predictive value; only 2.4% of patients (32 of 1,361) with a normal vital capacity (VC) on spirometry had a restrictive defect by TLC measurement. The probability of a restrictive defect was directly and linearly related to the degree of reduction of FVC when the FVC was < 80% of predicted (p = 6.002). Combining the FVC and the FEV1/FVC ratio improved the predictive ability of spirometry; for all values of FVC < 80% of the predicted amount, the likelihood of restrictive disease increased as the FEV1/FVC ratio increased. CONCLUSIONS: Spirometry is very useful at excluding a restrictive defect. When the VC is within the normal range, the probability of a restrictive defect is < 3%, and unless restrictive lung disease is suspected a priori, measurement of lung volumes can be avoided. However, spirometry is not able to accurately predict lung restriction; < 60% of patients with a classical spirometric restrictive pattern had pulmonary restriction confirmed on lung volume measurements. For these patients, measurement of the TLC is needed to confirm a true restrictive defect.

Adult↗
PubMed2006

Spirometry use in clinical practice following diagnosis of COPD.

BACKGROUND: Little is known about current use of pulmonary function testing in clinical practice. This study evaluated spirometry use in persons with COPD receiving care from the Veterans Health Administration health-care system. METHODS: Administrative data were used to identify a cohort of patients who were >/= 40 years of age with recently diagnosed COPD. Spirometry was identified using administrative data. Spirometry use was characterized over a 12-month period, and the use of spirometry around acute exacerbations and surgical procedures was examined. RESULTS: A total of 197,878 patients met the inclusion criteria in 1999. The average age was 67.5 years (SD, 10.0), and 98.2% of patients were male. A total of 66,744 patients (33.7%) underwent spirometry. The use of spirometry for newly diagnosed COPD patients decreased with age and was 3.3 times higher for those visiting pulmonologists. CONCLUSIONS: This study suggests that spirometry is inconsistently used in the diagnosis of COPD or the care of patients with COPD. This inconsistent pattern of use is seen even with the endorsement of spirometry use for patients with COPD by two national guidelines; however, the data predate the most recent version of the guidelines. It is unclear whether it is lack of physician knowledge of, attitudes about, or belief in the utility of spirometry that underlie the current patterns of physician use of this clinical tool.

Acute Disease↗
PubMed1991

Indications for spirometry in outpatients with respiratory disease.

It has been suggested that spirometry should be incorporated into the routine examination of every patient, analogous to obtaining vital signs. To determine the impact of spirometry on the management of outpatients with respiratory disease, spirometry was performed on 150 consecutive patients (123 men and 27 women, mean age 57 +/- 12 years) seen in our pulmonary disease outpatient clinics. Patients with obstructive (n = 75), restrictive (n = 31), mixed (n = 26) or other respiratory diseases (n = 18) were initially assessed by history and physical examination and classified as improved, stable, or worse compared to previous visits. A clinical management plan (CMP) was formulated based on this initial evaluation. Spirometric results were then made available to the examiner who could then make changes in the proposed CMP. The addition of spirometric results caused alteration of the CMP in only eight (5 percent) patients; in the remaining 142 patients, results did not affect the CMP. Two clinical findings identified those patients whose CMP was most likely to be altered by spirometry: severity of lung dysfunction (determined from previous spirometry) and deterioration of clinical status (judged by history and physical examination). Of the eight patients whose CMP was changed after review of spirometry, six (75 percent) had previous severe ventilatory dysfunction (FEV1 or FVC less than or equal to 40 percent of predicted or FEV1/FVC ratio less than or equal to 0.40). In 6 of 38 patients (16 percent) with severe ventilatory dysfunction, CMP was altered after spirometry while only 2 of 112 patients (1.8 percent) with mild or moderate dysfunction had changes in their CMP. Patients who were clinically assessed as worse compared to their previous visit were more likely to have their CMP altered after review of spirometry when compared to those considered improved or stable by a ratio of 6:1. These results suggest that spirometry is most likely to supplement the physician's history and physical examination in the management of outpatients with pulmonary disease when the initial evaluation suggests that the patient has clinically deteriorated since the previous clinic visit, or when he or she has previous severe ventilatory dysfunction.

Asthma↗
PubMed1997

Spirometry utilization in Ontario: practice patterns and policy implications.

OBJECTIVE: To describe growth and regional variation in the use of spirometry (flow studies) in Ontario. DESIGN: Retrospective analysis of Ontario Health Insurance Plan (OHIP) fee-for-service billing data for spirometry from the 1989-90 to 1994-95 fiscal years. SETTING: Physicians' office practices in Ontario. OUTCOME MEASURES: Number of flow studies and associated expenditures, number and specialty of physicians performing flow studies and the distribution of their billings, number of studies per capita by age group of patients, expenditures by region and measures of variation among regions. RESULTS: In 1994-95, $14.13 million was spent on flow studies in Ontario. This expenditure increased by 36.9% from 1989-90 to 1994-95, exceeding the overall growth rate of 20.8% for all expenditures under OHIP. Expenditure growth was driven by an increase in the number of physicians performing spirometry rather than a higher volume of services performed per physician. The substitution of flow-volume loops, for which the fee is higher, for simple spirograms also contributed to expenditure growth. There were wide regional variations in spirometry utilization. A small number of general practitioners and family physicians accounted for much of the regional variation. CONCLUSIONS: The rapid growth in spirometry utilization may stem from the diffusion of inexpensive spirometers in physicians' offices and from increased awareness of guidelines promoting the use of flow measurements. However, the wide regional variation in utilization may indicate either incomplete implementation of spirometry guidelines or lack of direction on the appropriate frequency of spirometry use. Clearer, evidence-based guidelines and an implementation strategy are needed. Also required is further study of possible inadequate access to spirometry in low-use regions and inappropriate use in high-use regions, where spirometry use is concentrated among a small number of physicians.

Adolescent↗