Walters Julia A E, Hansen Emily, Mudge Peter, Johns David P, Walters E Haydn, Wood-Baker Richard
University of Tasmania.
Aust Fam Physician. 2005 Mar;34(3):201-3.
Guidelines advise chronic obstructive pulmonary disease (COPD) should be diagnosed and managed by using spirometry to demonstrate irreversible airflow limitation and monitor change in smokers and ex-smokers aged over 35 years.
A cross-sectional study of patients and their general practitioners investigating use of spirometry in COPD in two practices by lung function assessment, review of practice records, interviews and focus groups.
Sixteen GPs, and 38 patients with a diagnosis of COPD participated. At diagnosis, although 72% had spirometry, this occurred in only 41% of 17 patients diagnosed by a GP; but in all 19 cases when a specialist was involved. Diagnosis often occurred late, despite all patients having previously recorded symptoms typical of COPD. General practitioners expressed a preference to diagnose COPD on clinical grounds. Although 58% of patients had recent spirometry for current management, only 32% were performed by their GP. There were organisational and technical barriers to spirometry and poor recognition of the essential role of spirometry in the diagnosis of COPD.
There are a number of potentially reversible factors that hinder practice recommendations regarding the use of spirometry in general practice to diagnose and manage COPD.
指南建议，慢性阻塞性肺疾病（COPD）的诊断和管理应通过肺活量测定法来证明不可逆的气流受限，并监测35岁以上吸烟者和既往吸烟者的病情变化。
一项针对患者及其全科医生的横断面研究，通过肺功能评估、查阅医疗记录、访谈和焦点小组调查了两家医疗机构中肺活量测定法在慢性阻塞性肺疾病中的使用情况。
16名全科医生和38名诊断为慢性阻塞性肺疾病的患者参与了研究。在诊断时，虽然72%的患者进行了肺活量测定，但在全科医生诊断的17例患者中，只有41%进行了此项检查；而在所有19例由专科医生参与诊断的病例中均进行了此项检查。尽管所有患者之前都记录有慢性阻塞性肺疾病的典型症状，但诊断往往较晚。全科医生表示倾向于基于临床症状诊断慢性阻塞性肺疾病。虽然58%的患者近期进行了肺活量测定以用于当前治疗，但只有32%是由其全科医生进行的。肺活量测定存在组织和技术障碍，且对肺活量测定在慢性阻塞性肺疾病诊断中的重要作用认识不足。
存在一些潜在的可逆因素阻碍了关于在全科医疗中使用肺活量测定法诊断和管理慢性阻塞性肺疾病的实践建议。
