Yawn Barbara P, Enright Paul L, Lemanske Robert F, Israel Elliot, Pace Wilson, Wollan Peter, Boushey Homer
Olmsted Medical Center, Department of Research, 210 Ninth St SE, Rochester, MN 55904, USA.
Chest. 2007 Oct;132(4):1162-8. doi: 10.1378/chest.06-2722. Epub 2007 Jun 5.
Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care.
To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry.
A before-and-after quasiexperimental design.
Three hundred eighty-two patients from 12 family medicine practices across the United States.
Patients with asthma and COPD, and staff from the 12 practices.
Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing.
Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD.
US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.
肺功能测定推荐用于阻塞性肺疾病的诊断和管理。虽然许多哮喘和慢性阻塞性肺疾病（COPD）患者由初级保健机构诊治，但关于初级保健中肺功能测定的使用情况及相关结果的数据有限。
评估门诊肺功能测定的技术适宜性、解读准确性及影响。
前后对照的半实验性设计。
来自美国12家家庭医学诊所的382名患者。
哮喘和COPD患者以及12家诊所的工作人员。
肺功能测定结果的技术适宜性、家庭医生与肺科专家对肺功能测定结果解读的一致性，以及肺功能测定后哮喘和COPD管理的变化。
在6个月内完成的368次检测中，71%在技术上适合解读。家庭医生和肺科专家的解读在76%的已完成检测中一致。48%完成检测的受试者在肺功能测定后管理发生了变化，包括107次药物调整（>85%与指南建议一致）和102次非药物调整。与COPD患者相比，哮喘患者中家庭医生和专家对肺功能测定结果解读的一致性更高。
美国家庭医生对哮喘和COPD患者进行肺功能测定及解读的比例与国际初级保健研究文献中公布的比例相当，且肺功能测定结果改变了治疗方案。
