PURPOSE: The majority of patients with clinically diagnosed chronic obstructive pulmonary disease (COPD) or asthma have their medical care provided by general physicians. However, for many individuals, the disease isclinically unrecognized or do not have their disease objectively verified by spirometry. Accordingly, the 2000 consensus statement from the National Lung Health Education Program recommends the widespread use of spirometry for patients patients at least 45 years old and who smoke cigarettes or who have chronic respiratory symptoms (exertional dyspnea, cough, and sputum production.) The general objective of the study was to determine to what extent spirometry was being utilized for screening and monitoring COPD or asthma in an appropriate population in our tertiary Medicine Outpatient Clinic supervised by academic clinicians.
METHODS: This retrospective review of records in our adult outpatient medical clinics evaluated whether spirometry was ordered, when clinically indicated. We used the following indications for spirometry: Age ≥ 45 years, and either: a) a clinical diagnosis of COPD or asthma, or b) current cigarette smoker, or c) presence of one or more of the following respiratory symptoms: exertional dyspnea, cough, sputum production. A ratio of the forced expiratory volume in one second (FEV1) to the forced vital capacity (FVC) < 0.70 was used to document the presence of chronic airflow limitation in COPD.Descriptive statistical analysis was used.
RESULTS: Spirometry was ordered in only 30% of the 380 patients we identified with clinical indications for this diagnostic test. Among those patients who were clinically diagnosis of COPD, 42% had spirometry confirmation of COPD with an FEV1/FVC <0.70. Furthermore, among these patients, 46% were correctly diagnosed with COPD based on the FEV1/FVC ratio. Among patients clinically diagnosed with asthma, only 30% had spirometry confirmation.
CONCLUSION: Spirometry is grossly underutilized by residents in our tertiary Medicine Outpatient Clinic.
CLINICAL IMPLICATIONS: Spirometry is necessary to screen for and diagnose individuals with obstructive airways disease, but it appears to be grossly underutilized. We should promote its usefulness to medical residents.
DISCLOSURE: Jose Angelo De Dios, None.