Spirometry in the primary care setting: influence on clinical diagnosis and management of airflow obstruction.

STUDY OBJECTIVE

To determine if screening spirometry in the primary care setting influences the physician's diagnosis and management of obstructive lung disease.

DESIGN

Diagnosis and management assessed before and after the intervention of screening spirometry.

PARTICIPANTS

A total of 1,034 patients who had ever smoked and were at least 35 years of age presenting to primary care practices for any reason.

SETTING

Rural primary care practices.

MEASUREMENTS AND RESULTS

Physicians were asked prior to and following presentation of spirometry test results if they thought airflow obstruction was present and if they planned to change management based on the results. A new diagnosis of unsuspected airflow obstruction was made by the physician in 93 patients (9%), and a prior diagnosis of airflow obstruction was removed after spirometry in 115 patients (11%). After viewing the spirometry results, physicians reported that they would change patient management in 154 patients (15%). Most planned management changes occurred when airflow obstruction was newly diagnosed (57 of 93 patients, 61%) and when the diagnosis of airflow obstruction remained unchanged (80 of 195 patients, 41%). A 6-month chart review documented the addition of respiratory medications in 8% of patients.

CONCLUSION

Screening spirometry influences physicians' diagnosis of airflow obstruction and management plans especially in patients with moderate-to-severe obstruction.