Enright Paul
The University of Arizona, Tucson, Arizona, USA.
Prim Care Respir J. 2008 Dec;17(4):238-42. doi: 10.3132/pcrj.2008.00065.
Spirometry programs (outside of primary care settings) designed to detect COPD in the general adult population are not justified, since the true positive yield (airway obstruction with an FEV1 below 60% predicted) is very low, and the false positive rate is very high. However, spirometry is greatly under-utilised by GPs who often prescribe inhalers for patients haphazardly. Inhalers for COPD are expensive and risk serious side-effects, so they should not be prescribed for current or former smokers without confirming severe airway obstruction. A large program in Finland has shown that some GPs can perform good quality spirometry. If good quality spirometry is not available in the GP's office, patients should be referred to a local resource for pre- and post-bronchodilator spirometry. More studies are needed to show that GPs use spirometry results systematically to make decisions which truly benefit their patients with asthma or COPD.
在普通成年人群中设计用于检测慢性阻塞性肺疾病（COPD）的肺功能测定项目（基层医疗环境之外）是不合理的，因为真正的阳性率（第一秒用力呼气容积[FEV1]低于预测值的60%的气道阻塞）非常低，而假阳性率非常高。然而，全科医生（GPs）对肺功能测定的利用严重不足，他们经常随意为患者开吸入器。治疗COPD的吸入器价格昂贵且有严重副作用的风险，所以在未确认存在严重气道阻塞的情况下，不应为现吸烟者或既往吸烟者开此类药物。芬兰的一个大型项目表明，一些全科医生能够进行高质量的肺功能测定。如果全科医生办公室无法提供高质量的肺功能测定，患者应被转诊至当地机构进行支气管扩张剂使用前后的肺功能测定。需要更多研究来表明全科医生是否系统地利用肺功能测定结果来做出真正有利于哮喘或COPD患者的决策。
