BACKGROUND: Spirometry is the 'gold standard' for diagnosing asthma and chronic obstructive pulmonary disease (COPD) but is rarely used in general practice. AIMS: To compare doctor diagnoses with patient reports/spirometry and to determine doctors' perceptions of spirometry. METHODS: Patients prescribed inhaled medication were recruited from 31 practices. Doctor diagnoses were extracted from practice records. Patients completed a questionnaire and spirometry before and after bronchodilator. In-depth interviews were conducted with a sample of doctors. RESULTS: Doctor diagnoses were available for 278 patients: asthma 192 (69%), COPD 38 (14%), asthma/COPD 40 (14%), and eight patients (3%) with other conditions. The diagnosis of asthma was correctly reported by 93% of patients, but only by 61% of those with COPD alone. Among those with both diagnoses, 83% reported asthma and 48% reported COPD. Of those with a diagnosis of COPD, 65% had fixed airflow limitation. Conversely, only 14% of those had been diagnosed with COPD alone. There was no significant difference in reversibility in forced expiratory volume in 1 second between diagnoses. While recognising the value of spirometry in differentiating between asthma and COPD, most general practices only used spirometry in diagnostically difficult cases. CONCLUSIONS: Doctor-diagnosed asthma is accurately reported by patients. However, COPD remains substantially under-diagnosed. Spirometry needs to be more widely used to improve the accuracy of respiratory diagnoses in general practice.
BACKGROUND: Spirometry is the 'gold standard' for diagnosing asthma and chronic obstructive pulmonary disease (COPD) but is rarely used in general practice. AIMS: To compare doctor diagnoses with patient reports/spirometry and to determine doctors' perceptions of spirometry. METHODS:Patients prescribed inhaled medication were recruited from 31 practices. Doctor diagnoses were extracted from practice records. Patients completed a questionnaire and spirometry before and after bronchodilator. In-depth interviews were conducted with a sample of doctors. RESULTS: Doctor diagnoses were available for 278 patients: asthma 192 (69%), COPD 38 (14%), asthma/COPD 40 (14%), and eight patients (3%) with other conditions. The diagnosis of asthma was correctly reported by 93% of patients, but only by 61% of those with COPD alone. Among those with both diagnoses, 83% reported asthma and 48% reported COPD. Of those with a diagnosis of COPD, 65% had fixed airflow limitation. Conversely, only 14% of those had been diagnosed with COPD alone. There was no significant difference in reversibility in forced expiratory volume in 1 second between diagnoses. While recognising the value of spirometry in differentiating between asthma and COPD, most general practices only used spirometry in diagnostically difficult cases. CONCLUSIONS: Doctor-diagnosed asthma is accurately reported by patients. However, COPD remains substantially under-diagnosed. Spirometry needs to be more widely used to improve the accuracy of respiratory diagnoses in general practice.
Authors: Sankar D Navaneethan; Jesse D Schold; Haiquan Huang; Georges Nakhoul; Stacey E Jolly; Susana Arrigain; Raed A Dweik; Joseph V Nally Journal: Am J Nephrol Date: 2016-02-19 Impact factor: 3.754
Authors: Jeff D Overington; Yao C Huang; Michael J Abramson; Juliet L Brown; John R Goddard; Rayleen V Bowman; Kwun M Fong; Ian A Yang Journal: J Thorac Dis Date: 2014-11 Impact factor: 2.895
Authors: Rachel Denholm; Joachim Schüz; Kurt Straif; Isabelle Stücker; Karl-Heinz Jöckel; Darren R Brenner; Sara De Matteis; Paolo Boffetta; Florence Guida; Irene Brüske; Heinz-Erich Wichmann; Maria Teresa Landi; Neil Caporaso; Jack Siemiatycki; Wolfgang Ahrens; Hermann Pohlabeln; David Zaridze; John K Field; John McLaughlin; Paul Demers; Neonila Szeszenia-Dabrowska; Jolanta Lissowska; Peter Rudnai; Eleonora Fabianova; Rodica Stanescu Dumitru; Vladimir Bencko; Lenka Foretova; Vladimir Janout; Benjamin Kendzia; Susan Peters; Thomas Behrens; Roel Vermeulen; Thomas Brüning; Hans Kromhout; Ann C Olsson Journal: Am J Respir Crit Care Med Date: 2014-09-01 Impact factor: 21.405
Authors: Ross T Tsuyuki; William Midodzi; Cristina Villa-Roel; Darcy Marciniuk; Irvin Mayers; Dilini Vethanayagam; Michael Chan; Brian H Rowe Journal: CMAJ Open Date: 2020-09-25