Quality of spirometry and related diagnosis in primary care with a focus on clinical use

S J Van De Hei,H J Baretta,J W K Van Den Berg,T R J Schermer,T Van Der Molen,K W Patberg,N E Doornewaard,I Steenbruggen,J W H Kocks,E C M Ruberg,B M J Flokstra-De Blok

doi:10.1038/s41533-020-0177-z

Abstract

American and European societies’ (ATS/ERS) criteria for spirometry are often not met in primary care. Yet, it is unknown if quality is sufficient for daily clinical use. We evaluated quality of spirometry in primary care based on clinical usefulness, meeting ATS/ERS criteria and agreement on diagnosis between general practitioners (GPs) and pulmonologists. GPs included ten consecutive spirometry tests and detailed history questionnaires of patients who underwent spirometry as part of usual care. GPs and two pulmonologists assessed the spirometry tests and questionnaires on clinical usefulness and formulated a diagnosis. In total, 149 participants covering 15 GPs were included. Low agreements were found on diagnosis between GPs and pulmonologists 1 (κ = 0.39) and 2 (κ = 0.44). GPs and pulmonologists rated >88% of the tests as clinically useful, although 13% met ATS/ERS criteria. This real-life study demonstrated that clinical usefulness of routine primary care spirometry tests was high, although agreement on diagnosis was low.

Highlights

Chronic airway diseases occur frequently, and it is estimated that more than 300 million people suffer from asthma worldwide and approximately 170 million people are affected by chronic obstructive pulmonary disease (COPD)[1]
We evaluated the quality of spirometry by agreement on respiratory diagnosis between general practitioners (GPs) and pulmonologists in a real-life setting
We found a low agreement on respiratory diagnosis between GPs and pulmonologists and between the pulmonologists

Summary

Introduction

Chronic airway diseases occur frequently, and it is estimated that more than 300 million people suffer from asthma worldwide and approximately 170 million people are affected by chronic obstructive pulmonary disease (COPD)[1]. Spirometry is essential for diagnosing airway obstruction and monitoring chronic respiratory diseases and is recommended in national and international guidelines[2,3,4,5]. Because most of the respiratory patients are diagnosed and managed by their general practitioner, spirometry is commonly used in primary care[6]. Performing spirometry in primary care lowers the burden for patients by preventing hospital visits, reduces the costs and provides quick results for the general practitioner (GP). General Practices had access to a spirometry facility, with twothird of the practices making use of their own spirometer[6]. Good-quality spirometry requires reliable equipment, cooperation between a well-trained operator and a motivated patient, and an experienced interpreter[7]. Education demonstrated a positive effect on the quality of spirometry in primary care[8,9]. Conducting spirometry frequently seems important to maintain the ability for accurate measurements[9]

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