Quality Assured Spirometry Research Articles

Inhaled therapy for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio <0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.

Inhaled therapy for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio <0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.

Case-finding of chronic obstructive pulmonary disease with questionnaire, peak flow measurements and spirometry: a cross-sectional study.

BackgroundSpirometry is commonly accepted as the gold standard for the diagnosis of COPD, but the reality remains that quality assured spirometry is not or cannot be provided universally around the globe. Adding PEF measurement to a screening questionnaire may rule out airflow limitation compatible with COPD rationalizing spirometry testing.MethodsWe conducted a cross-sectional survey in a sample of individuals 40–80 yrs. old in Dubai, UAE. They were invited to answer a short socio-demographic questionnaire including a report on current, past history of smoking, and had PEF measured, then they conducted spirometry to identify airflow limitation compatible with COPD.ResultsOverall, 525 (91.0%) participants performed PEF and spirometry (68% male, with a mean age of 59 years, 17% UAE Nationals), 24% reported smoking of different sorts. Overall, 68 participants (12.9%, 95% C.I. 10.3% to 16.1%) had airflow limitation compatible with COPD. PEFR alone identified 141participants with airflow limitation compatible with COPD, with specificity of 80% and sensitivity of 73.5%.ConclusionsPEFR could be an easy, cheap, and non-biased tool to assist with the case-finding of COPD before confirmation with spirometry.

A centralised respiratory diagnostic service for primary care: a 4-year audit

The literature shows that delayed or erroneous diagnosis of respiratory conditions may be common in primary care due to underuse of spirometry or poor spirometric technique. The Community Respiratory Assessment Unit (CRAU) was established to optimise diagnosis and treatment of respiratory disease by providing focused history-taking, quality-assured spirometry, and evidence-based guideline-derived management advice. To review the service provided by the CRAU to primary care health professionals. Data from 1,156 consecutive GP referrals over 4 years were analysed. From the 1,156 referrals, 666 were referred for one of five common reasons: suspected asthma, confirmed asthma, suspected chronic obstructive pulmonary disease (COPD), confirmed COPD, or unexplained breathlessness. COPD was the most prevalent referral indication (445/666, 66.8%), but one-third of suggested diagnoses of COPD by the GP were found to be incorrect (161/445, 36%) with inappropriate prescribing of inhaled therapies resulting from this misdiagnosis. Restrictive pulmonary defects (56/666, 8% of referrals) were overlooked and often mistaken for obstructive conditions. The potential for obesity to cause breathlessness may not be fully appreciated. Misdiagnosis has significant financial, ethical, and safety implications. This risk may be minimised by better support for primary care physicians such as diagnostic centres (CRAU) or alternative peripatetic practice-based services operating to quality-controlled standards.

Management of COPD in primary care in Leicestershire

Chronic Obstructive Airways Disease (COPD) is a common treatable condition suitable for primary care given certain prerequisites. These are disease specific registers, protocols and clinics and access to quality assured spirometry for accurate diagnosis and monitoring of disease progression. To determine proportion of practices with COPD registers, protocols and clinics and the resources to provide high quality spirometry. A postal survey of the identified lead respiratory nurse and doctor in 147 Leicestershire practices. Reminders were sent after six weeks of non-response. Further telephone questionnaires were sent to non-responders after twelve weeks. The response rate was 61%. 43 (49%) responding practices had COPD protocols, 49 (54%) practices had COPD registers and 8 (9%) practices had COPD clinics. 50 (56%) practices owned one or more spirometers and 13 (15%) had at least 1 person with current (within the last 2 years) approved/formal training in performing spirometry. Only 4 (4%) of practices had COPD protocols, registers and clinics and trained operators with current training. Very few practices in Leicestershire have the prerequisites to provide high quality of primary care of COPD. Maintenance of current approved training for spirometry operator is likely to be a major continuing barrier to providing high quality practice based primary care of COPD. This may be best provided at a locality level by intermediate care.