PURPOSE: To better understand factors related to spirometry use by primary care physicians (PCPs) for diagnosing COPD.
METHODS: A questionnaire developed by an expert steering committee was administered to 166 Canadian PCPs assessing patient office visits between May - July 2009. Office visits for patients ≥40 years of age, smoker or ex-smoker, who answered yes to any question in the Canadian Lung Association COPD questionnaire were eligible for enrolment. Patients with previously confirmed COPD were excluded.
RESULTS: 3,275 patient visits were enrolled, 31% of visits were for respiratory reasons. 69.1% of patients reported a regular cough, 44.5% produced phlegm regularly, 36.4% experienced shortness of breath with simple chores, 33.2% wheezed with exertion, and 32.4% noted frequent colds. Spirometry was ordered in 47.3% of patients, more often in patients <1 year (ordered spirometry 9.7% vs did not order spirometry 4.6%) and <5 years (25.0% vs 16.5%) in their practice, cough or shortness of breath (25.6% vs 19.8%), increased dyspnea (MRC 2 40.0% vs 34.6%, MRC 3 19.1% vs 12.5%), and in patients whose physician felt respiratory symptoms affected their activity (66.6% vs 50.5%). The most common reasons for not ordering spirometry included believing the results wouldn’t change therapy (33.9%), other medical priorities (30.5%), limited access (18.6%), and assuming results will be normal (9.9%). 43% of physicians reported being somewhat or not at all comfortable in diagnosing COPD, while 52% were somewhat or not at all comfortable differentiating between asthma and COPD.
CONCLUSION: Spirometry is not consistently requested for symptomatic patients at risk for COPD, but is increasingly ordered in more symptomatic patients. The finding that PCPs do not universally report confidence in establishing the diagnosis of COPD potentially affects the use of spirometry in this clinical setting.
CLINICAL IMPLICATIONS: Enabling PCPs to gain confidence in making the diagnosis of COPD would likely lead to increased utilization of spirometry in assessing symptomatic patients at risk for COPD.
DISCLOSURE: Darcy Marciniuk, University grant monies University of Alberta, University of Ottawa; Grant monies (from sources other than industry) Canadian Institute of Health Research, Lung Association of Saskatchewan, Saskatchewan Health Research Foundation; Grant monies (from industry related sources) Astra Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Schering-Plough; Employee University of Saskatchewan; Fiduciary position (of any organization, association, society, etc, other than ACCP Canadian COPD Alliance, Saskatchewan Lung Association; Consultant fee, speaker bureau, advisory committee, etc. Astra Zeneca, Boehringer Ingelheim, Canadian Lung Association, GlaxoSmithKline, Health Canada, Health Quality Council, Nycomed, Pfizer, Saskatchewan Ministry of Health, Saskatoon Health Region; No Product/Research Disclosure Information