School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW. n.zwarATunsw.edu.au
Med J Aust. 2011 Aug 15;195(4):168-71. doi: 10.5694/j.1326-5377.2011.tb03271.x.
To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses.
DESIGN, SETTING AND PARTICIPANTS: General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients.
Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses.
56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49% male). Of these, 257 (57.8%) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis.
A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.
比较慢性阻塞性肺疾病（COPD）的临床诊断与普通科医生支气管扩张剂后肺功能检查的结果，并探讨与临床和肺功能诊断一致性相关的医生、实践和患者特征。
设计、地点和参与者：悉尼的全科医生从过去一年中就诊并开有呼吸药物的符合条件的 40-80 岁患者中确定了 COPD 患者。在 2006 年 11 月至 2008 年 4 月期间，我们收集了全科医生及其诊所的信息，以及患者的人口统计学信息、吸烟状况、合并症、呼吸药物使用、疫苗接种状况、生活质量和肺功能检查结果。
肺功能检查中 COPD 诊断的频率；与临床和肺功能诊断一致性相关的特征的比值比。
44 家诊所的 56 名全科医生参与了该研究。在 1144 名符合条件的患者中，有 445 名患者（平均年龄 65 岁；49%为男性）入选。其中，257 名（57.8%）患者的支气管扩张剂后肺功能检查结果符合 COPD ± 哮喘，16 名（3.6%）患者仅有哮喘，82 名（18.4%）患者肺功能正常，90 名（20.2%）患者有其他肺功能诊断。诊所中是否有肺功能仪与临床和肺功能诊断的一致性无相关性。患者年龄较大与正确诊断显著相关，而合并症数量较多与误诊相关。
相当一部分在普通科医生中被临床诊断为 COPD 的患者根据肺功能标准实际上并没有这种疾病，合并症较多的患者更容易误诊。需要改变政策和实践，以支持在初级保健中使用肺功能检查。
