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.
RCT Entities:
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.
Authors: M Decramer; R Gosselink; M Rutten-Van Mölken; J Buffels; O Van Schayck; P-A Gevenois; R Pellegrino; E Derom; W De Backer Journal: Thorax Date: 2005-04 Impact factor: 9.139
Authors: Rachel E Jordan; Kin-bong Hubert Lam; Kar Keung Cheng; Martin R Miller; Jennifer L Marsh; Jon G Ayres; David Fitzmaurice; Peymané Adab Journal: Thorax Date: 2010-06 Impact factor: 9.139
Authors: Barbara P Yawn; Douglas W Mapel; David M Mannino; Fernando J Martinez; James F Donohue; Nicola A Hanania; Mark Kosinski; Regina Rendas-Baum; Matthew Mintz; Steven Samuels; Anand A Dalal Journal: Int J Chron Obstruct Pulmon Dis Date: 2010-02-18