Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
NPJ Prim Care Respir Med. 2022 Sep 5;32(1):32. doi: 10.1038/s41533-022-00298-4.
Asthma and COPD are defined as different disease entities, but in practice patients often show features of both diseases making it challenging for primary care clinicians to establish a correct diagnosis. We aimed to establish the added value of spirometry and more advanced lung function measurements to differentiate between asthma and COPD. A cross-sectional study in 10 Dutch general practices was performed. 532 subjects were extensively screened on respiratory symptoms and lung function. Two chest physicians assessed if asthma or COPD was present. Using multivariable logistic regression analysis we assessed the ability of three scenarios (i.e. only patient history; diagnostics available to primary care; diagnostics available only to secondary care) to differentiate between the two conditions. Receiver operator characteristics (ROC) curves and area under the curve (AUC) were calculated for each scenario, with the chest physicians' assessment as golden standard. Results showed that 84 subjects were diagnosed with asthma, 138 with COPD, and 310 with no chronic respiratory disease. In the scenario including only patient history items, ROC characteristics of the model showed an AUC of 0.84 (95% CI 0.78-0.89) for differentiation between asthma and COPD. When adding diagnostics available to primary care (i.e., pre- and postbronchodilator spirometry) AUC increased to 0.89 (95% CI 0.84-0.93; p = 0.020). When adding more advanced secondary care diagnostic tests AUC remained 0.89 (95% CI 0.85-0.94; p = 0.967). We conclude that primary care clinicians' ability to differentiate between asthma and COPD is enhanced by spirometry testing. More advanced diagnostic tests used in hospital care settings do not seem to provide a better overall diagnostic differentiation between asthma and COPD in primary care patients.
哮喘和 COPD 被定义为不同的疾病实体，但实际上患者常常表现出两种疾病的特征，这使得初级保健临床医生难以做出正确的诊断。我们旨在确定肺功能测定和更先进的肺功能测量在区分哮喘和 COPD 方面的附加值。在 10 家荷兰普通诊所进行了一项横断面研究。对 532 名受试者进行了广泛的呼吸症状和肺功能筛查。两位胸部医生评估是否存在哮喘或 COPD。我们使用多变量逻辑回归分析评估了三种情况（即仅患者病史；初级保健可用的诊断；仅二级保健可用的诊断）区分两种情况的能力。为每个方案计算了接收者操作特性 (ROC) 曲线和曲线下面积 (AUC)，并以胸部医生的评估为金标准。结果显示，84 名受试者被诊断为哮喘，138 名受试者被诊断为 COPD，310 名受试者没有慢性呼吸道疾病。在仅包括患者病史项目的方案中，模型的 ROC 特征显示区分哮喘和 COPD 的 AUC 为 0.84（95%CI 0.78-0.89）。当添加初级保健可用的诊断（即，支气管扩张剂前后肺功能测定）时，AUC 增加到 0.89（95%CI 0.84-0.93；p=0.020）。当添加更先进的二级保健诊断测试时，AUC 仍然为 0.89（95%CI 0.85-0.94；p=0.967）。我们得出结论，通过肺功能测试，初级保健临床医生区分哮喘和 COPD 的能力得到增强。在初级保健患者中，医院护理环境中使用的更先进的诊断测试似乎并不能提供更好的哮喘和 COPD 总体诊断区分。
