Skip to main content

Advertisement

Log in

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results.

Objectives

To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry.

Design

Retrospective cohort study.

Subjects

A cohort that met the following criteria was identified: ≥35 years of age; ≥ 2 primary care visits in internal medicine clinic in 2007; at least one respiratory or smoking cessation medication, or diagnosis of COPD or shortness of breath or dyspnea in 2007.

Main Measures

Medical records of all primary care physician visits prior to the time of inclusion in 2007 were reviewed. Data on patient demographics, co-morbidities, respiratory medication use, presence of symptoms, history of tobacco use, and pulmonary function tests were extracted.

Key Results

A total 1052 patients were identified. Dyspnea on exertion (Adjusted odds ratio (AOR) 1.52 [95% CI 1.06–2.18]) and chronic cough (AOR 1.71 [1.07–2.72]) were the only chronic symptoms associated with use of spirometry. Current (AOR 1.54 [0.99–2.40]) or past smoking (AOR 1.09 [0.72–1.65]) status were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD.

Conclusion

Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.

    Article  PubMed  CAS  Google Scholar 

  2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. December 2010; http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed June 3, 2011.

  3. Han MK, Kim MG, Mardon R, et al. Spirometry utilization for COPD: how do we measure up? Chest. 2007;132:403–9.

    Article  PubMed  Google Scholar 

  4. Joo MJ, Lee TA, Weiss KB. Geographic variation of spirometry use in newly diagnosed COPD. Chest. 2008;134:38–45.

    Article  PubMed  Google Scholar 

  5. Lee TA, Bartle B, Weiss KB. Spirometry use in clinical practice following diagnosis of COPD. Chest. 2006;129:1509–15.

    Article  PubMed  Google Scholar 

  6. Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. Bmj. 2000;320:1297–303.

    Article  PubMed  CAS  Google Scholar 

  7. Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.

    Article  PubMed  CAS  Google Scholar 

  8. Donohue JF, van Noord JA, Bateman ED, et al. A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest. 2002;122:47–55.

    Article  PubMed  CAS  Google Scholar 

  9. Gartlehner G, Hansen RA, Carson SS, Lohr KN. Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Ann Fam Med. 2006;4:253–62.

    Article  PubMed  Google Scholar 

  10. Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med. 1997;155:1283–9.

    PubMed  CAS  Google Scholar 

  11. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med. 2000;343:1902–9.

    Article  Google Scholar 

  12. Macie C, Wooldrage K, Manfreda J, Anthonisen NR. Inhaled corticosteroids and mortality in COPD. Chest. 2006;130:640–6.

    Article  PubMed  CAS  Google Scholar 

  13. Ram FS, Sestini P. Regular inhaled short acting beta2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. Thorax. 2003;58:580–4.

    Article  PubMed  CAS  Google Scholar 

  14. Ramirez-Venegas A, Ward J, Lentine T, Mahler DA. Salmeterol reduces dyspnea and improves lung function in patients with COPD. Chest. 1997;112:336–40.

    Article  PubMed  CAS  Google Scholar 

  15. Rennard SI, Anderson W, ZuWallack R, et al. Use of a long-acting inhaled beta2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:1087–92.

    PubMed  CAS  Google Scholar 

  16. Stockley RA, Chopra N, Rice L. Addition of salmeterol to existing treatment in patients with COPD: a 12 month study. Thorax. 2006;61:122–8.

    Article  PubMed  CAS  Google Scholar 

  17. Stockley RA, Whitehead PJ, Williams MK. Improved outcomes in patients with chronic obstructive pulmonary disease treated with salmeterol compared with placebo/usual therapy: results of a meta-analysis. Respir Res. 2006;7:147.

    Article  PubMed  Google Scholar 

  18. van Noord JA, Aumann JL, Janssens E, et al. Effects of tiotropium with and without formoterol on airflow obstruction and resting hyperinflation in patients with COPD. Chest. 2006;129:509–17.

    Article  PubMed  Google Scholar 

  19. Wadbo M, Lofdahl CG, Larsson K, et al. Effects of formoterol and ipratropium bromide in COPD: a 3-month placebo-controlled study. Eur Respir J. 2002;20:1138–46.

    Article  PubMed  CAS  Google Scholar 

  20. Dewan NA, Rafique S, Kanwar B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest. 2000;117:662–71.

    Article  PubMed  CAS  Google Scholar 

  21. Alsaeedi A, Sin DD, McAlister FA. The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials. Am J Med. 2002;113:59–65.

    Article  PubMed  CAS  Google Scholar 

  22. Ernst P, Gonzalez AV, Brassard P, Suissa S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med. 2007;176:162–6.

    Article  PubMed  CAS  Google Scholar 

  23. Kardos P, Wencker M, Glaab T, Vogelmeier C. Impact of salmeterol/fluticasone propionate versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;175:144–9.

    Article  PubMed  CAS  Google Scholar 

  24. Lee TA, Weiss KB. Fracture risk associated with inhaled corticosteroid use in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169:855–9.

    Article  PubMed  Google Scholar 

  25. Joo MJ, Au DH, Fitzgibbon ML, Lee TA. Inhaled corticosteroids and risk of pneumonia in newly diagnosed COPD. Respir Med.104:246–52.

  26. Jenkins CR, Jones PW, Calverley PM, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009;10:59.

    PubMed  Google Scholar 

  27. Decramer M, Celli B, Kesten S, Lystig T, Mehra S, Tashkin DP. Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet. 2009;374:1171–8.

    Article  PubMed  CAS  Google Scholar 

  28. Johansson G, Lindberg A, Romberg K, Nordstrom L, Gerken F, Roquet A. Bronchodilator efficacy of tiotropium in patients with mild to moderate COPD. Prim Care Respir J. 2008;17:169–75.

    Article  PubMed  Google Scholar 

  29. National Committee for Quality Assurance (NCQA). HEDIS 2010. Technical Specifications for Physician Measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2009:.

  30. Hansen JE, Sun XG, Wasserman K. Discriminating measures and normal values for expiratory obstruction. Chest. 2006;129:369–77.

    Article  PubMed  Google Scholar 

  31. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.

    Article  PubMed  CAS  Google Scholar 

  32. U. S. Preventive Services Task Force. Screening for chronic obstructive pulmonary disease using spirometry: U.S. preventive services task force recommendation statement. Ann Intern Med. 2008;148:529–34.

    Google Scholar 

  33. Jaen CR, McIlvain H, Pol L, Phillips RL Jr, Flocke S, Crabtree BF. Tailoring tobacco counseling to the competing demands in the clinical encounter. J Fam Pract. 2001;50:859–63.

    PubMed  CAS  Google Scholar 

Download references

Contributors

The authors would like to thank Rebecca Michaelis, research assistant, who participated in the chart reviews.

Funders

This work was supported by the National Heart, Lung, and Blood Institute [K23HL094461]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, the National Institutes. The views expressed in this manuscript reflect those of the authors and not necessarily those of the Department of Veterans Affairs.

Prior Presentations

An abstract of preliminary data from this study was presented in poster form at that American Thoracic Society meeting in New Orleans, LA in May, 2010 and in Denver, CO in May 2011.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Min J Joo MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Joo, M.J., Au, D.H., Fitzgibbon, M.L. et al. Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care. J GEN INTERN MED 26, 1272–1277 (2011). https://doi.org/10.1007/s11606-011-1770-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-011-1770-1

Key words

Navigation