Giraud Violaine, Beauchet Alain, Gomis Thierry, Chinet Thierry
AP-HP, Department of Pneumology and Thoracic Oncology, Ambroise-Paré Hospital, Paris, France; UEFR Paris île-de-France Ouest, Versailles Saint Quentin-en-Yvelines University, Paris, France.
Public Health Department, Unité de Recherche Clinique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France.
Int J Chron Obstruct Pulmon Dis. 2016 Feb 12;11:335-40. doi: 10.2147/COPD.S96385. eCollection 2016.
COPD is a frequent but underdiagnosed disease whose diagnosis relies on the spirometric demonstration of bronchial obstruction. Spirometry use by general practitioners could represent the first line in COPD diagnosis.
Because duration of spirometry is retarding its development in primary care, we decided to measure the time it requires in the primary-care context in France.
Ten volunteer general practitioners were trained during two 3-hour theoretical and practical continuing education sessions. Then, from October 2013 to May 2014, they included patients without any known respiratory disease but at risk of developing COPD (age: ≥40 years, smoker: ≥20 pack-years). The duration of spirometry and its quality were evaluated according to the following acceptability criteria: 1) expiration ≥6 seconds or reaching a plateau; 2) good start with an early peak flow, curve peaked on top and not flat; 3) no artifacts; and 4) reproducibility criteria, ie, forced expiratory volume in 1 second and forced vital capacity differences between the two best spirometry curves ≤0.15 L. Quality of the spirograms was defined as optimal when all the criteria were met and acceptable when all the criteria were satisfied except the reproducibility criterion, otherwise, it was unacceptable.
For the 152 patients included, the 142 assessable spirometries lasted for 15.2±5.9 minutes. Acceptability criteria 1-3, respectively, were satisfied for 90.1%, 89.4%, and 91.5% of patients and reproducibility criterion 4 for 56.3%. Quality was considered optimal for 58.5% of the curves and acceptable for 30.2%.
The duration of spirometry renders it poorly compatible with the current primary-care practice in France other than for dedicated consultations. Moreover, the quality of spirometry needs to be improved.
慢性阻塞性肺疾病（COPD）是一种常见但诊断不足的疾病，其诊断依赖于支气管阻塞的肺量计测定。全科医生使用肺量计可能是COPD诊断的第一线方法。
由于肺量计测定时间阻碍了其在初级保健中的发展，我们决定测量其在法国初级保健环境中所需的时间。
10名志愿全科医生在两次3小时的理论和实践继续教育课程中接受培训。然后，从2013年10月至2014年5月，他们纳入了没有任何已知呼吸系统疾病但有患COPD风险的患者（年龄：≥40岁，吸烟者：≥20包年）。根据以下可接受性标准评估肺量计测定的时间及其质量：1）呼气≥6秒或达到平台期；2）起始良好，早期峰值流速高，曲线顶部呈峰值而非平坦；3）无伪像；4）重复性标准，即两次最佳肺量计曲线之间的第1秒用力呼气量和用力肺活量差异≤0.15L。当所有标准都满足时，肺量图质量定义为最佳；当除重复性标准外所有标准都满足时，定义为可接受；否则，定义为不可接受。
对于纳入的152例患者，142次可评估的肺量计测定持续了15.2±5.9分钟。分别有90.1%、89.4%和91.5%的患者满足可接受性标准1 - 3，56.3%的患者满足重复性标准4。58.5%的曲线质量被认为是最佳的，30.2%是可接受的。
肺量计测定时间使其与法国当前的初级保健实践不太兼容，除非是专门的会诊。此外，肺量计测定的质量需要提高。
