Service d'éxplorations fonctionnelles respiratoires, centre hospitalier régional universitaire (CHRU), 25000 Besançon, France; Service de pneumologie, CHRU, 25000 Besançon, France.
Équipe d'epidémiologie environnementale, institute for advanced biosciences, centre de recherche UGA, inserm U1209, CNRS UMR 5309, 38040 Grenoble, France.
Respir Med Res. 2020 Mar;77:31-36. doi: 10.1016/j.resmer.2019.07.004. Epub 2019 Jul 18.
Proper diagnosis of COPD remains a challenge. Spirometry testing in primary care may help to reduce misdiagnosis, but its reliability as a diagnostic instrument needs to be assessed.
To investigate (1) the validity of spirometry testing performed in primary care and (2) the accuracy of the diagnostic of airflow limitation obtained by these tests.
Subjects attending a COPD screening programme had screening spirometry performed either by general practitioners (GPs) or by trained nurses or technicians, who had all received two 3-hour training sessions. Subjects with airflow limitation and a subset of subjects with normal spirometry at screening were invited to undergo confirmatory spirometry performed by trained nurses in a pulmonary function laboratory.
Of the 4610 subjects who attended the screening sessions, 96.5% had a valid screening spirometry test. A total of 392 subjects attended the confirmatory sessions. Values measured by screening spirometry were satisfactory compared with those of confirmatory spirometry (r=0.83). Taking confirmatory spirometry as reference, the positive predictive value of screening spirometry for the diagnosis of persistent airflow limitation was 93% with a specificity of 95%. Agreement for the diagnosis of persistent airflow limitation was substantial (k=0.80).
Spirometry performed in primary care by trained personnel reliably identifies persistent airflow limitation. This may encourage pulmonologists to collaborate with primary care providers with the aim of improving appropriate diagnosis of COPD.
正确诊断 COPD 仍然具有挑战性。在初级保健中进行肺量计检查可能有助于减少误诊，但需要评估其作为诊断工具的可靠性。
调查（1）初级保健中进行的肺量计检查的有效性，以及（2）这些检查得出的气流受限诊断的准确性。
参加 COPD 筛查计划的受试者由全科医生（GP）或经过培训的护士或技师进行筛查肺量计检查，他们都接受了两次 3 小时的培训课程。有气流受限的受试者和筛查时肺功能正常的一部分受试者被邀请在肺功能实验室由经过培训的护士进行确认性肺量计检查。
在参加筛查会议的 4610 名受试者中，96.5%的人进行了有效的筛查肺量计检查。共有 392 名受试者参加了确认性会议。与确认性肺量计相比，筛查肺量计测量的值令人满意（r=0.83）。以确认性肺量计为参考，筛查肺量计对持续性气流受限的诊断的阳性预测值为 93%，特异性为 95%。持续性气流受限的诊断一致性较高（k=0.80）。
由经过培训的人员在初级保健中进行的肺量计检查可靠地识别持续性气流受限。这可能鼓励肺病专家与初级保健提供者合作，以提高 COPD 的适当诊断。
