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Communications to the Editor |

Underuse of Spirometry in Primary Care FREE TO VIEW

Salvador Díaz-Lobato, PhD; Sagrario Mayoralas, MD
Author and Funding Information

Affiliations: Hospital La Paz and Hospital de Móstoles, Madrid, Spain,  Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium

Correspondence to: Salvador Díaz-Lobato, PhD, C/Federico García Lorca, 2, portal 7, 2°A, 28770-Colmenar Viejo-Madrid, Spain; e-mail: sdl01m@nacom.es



Chest. 2004;126(5):1712-1713. doi:10.1378/chest.126.5.1712
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Published online

To the Editor:

We read with great interest the article recently published by Buffels et al in CHEST (April 2004).1 According to the authors, spirometry in general practice is feasible to perform and is sufficiently accurate. In addition, spirometry allows us to establish diagnoses of COPD and asthma in patients with formerly unknown obstructive lung disease (OLD). The authors concluded that the use of spirometry is mandatory if the early stages of OLD are to be detected in a general practice, since it is quite probable that the majority of the patients with unidentified COPD first consult with a general practitioner (GP). In the experience of Buffels et al,1 screening for airflow obstruction, doubled the number of patients known to have OLD.

However, reality is quite different. In our health system, spirometry is a technique that is largely unknown in primary care centers. In an urban area that depends on our teaching hospital for health care, there are 24 primary care centers attending a population of 700,000 inhabitants. Previous studies2 have demonstrated a COPD prevalence of 9% among people 35 to 60 years of age in our country, of whom 78% are unaware that they have the disease. Despite this situation, only 18 centers have spirometry equipment, 3 of which do not perform spirometry at all. The remaining centers perform an average of two spirometry procedures per week. It is evident that, as a result, there is a loss of motivation to perform spirometry and a loss of sensitivity in using this useful and necessary diagnostic tool on the part of the GP.

It is clear that it is important to receive adequate respiratory training in general practice, including aspects of the diagnosis and management of asthma and COPD, as well as training in the performance of spirometry and the interpretation of its results. Health authorities must be sensitive to this problem and must provide continuous technical and methodological support to the GP. Primary care doctors should be stimulated to search for patients with OLD that is in the early stages, and to take the results of spirometry into account.

Buffels, J, Degryse, J, Heyrman, J, et al (2004) Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study.Chest125,1394-1399. [CrossRef] [PubMed]
 
Pena, VS, Miravitlles, M, Gabriel, R, et al Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study.Chest2000;118,981-989. [CrossRef] [PubMed]
 
To the Editor:

We agree with the authors that spirometry remains an unknown technique to a majority of general practitioners. Microspirometers that enable the widespread use of office spirometry are a relatively new phenomenon. Until now, only a few studies have tested the accuracy and the reliability of these devices. The technique is probably too recent to reach a generalized use in primary care.

Furthermore, in several countries, the performance and the interpretation of lung function tests are not included in the basic training of general practitioners. The potential importance of spirometry has probably been underestimated until now. We agree with Salvador Diaz-Lobato that adequate respiratory training should be encouraged for primary care physicians. This could optimize early detection and appropriate care for patients suffering from asthma or COPD. In Belgium, we are starting with specific training in office spirometry, in a joint group of pulmonologists and general practitioners. We will report later about the effects of this project.


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References

Buffels, J, Degryse, J, Heyrman, J, et al (2004) Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study.Chest125,1394-1399. [CrossRef] [PubMed]
 
Pena, VS, Miravitlles, M, Gabriel, R, et al Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study.Chest2000;118,981-989. [CrossRef] [PubMed]
 
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