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Bhandari SK, Bist A, Ghimire A. Single breath count test and its applications in clinical practice: a systematic review. Ann Med Surg (Lond) 2024; 86:2130-2136. [PMID: 38576972 PMCID: PMC10990392 DOI: 10.1097/ms9.0000000000001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Background Single breath count test (SBCT) may be a reproducible, rapid, easy to perform and easy to interpret substitute to spirometry especially in low resource settings for certain conditions. Its interest has been rekindled with the recent COVID-19 pandemic and it can be done as a part of tele-medicine as well. Objectives The objective of this review was to summarize the evidence of SBCT in clinical practice. Methods The authors searched EMBASE, PubMed and Google Scholar for all the relevant articles as per exclusion and inclusion criteria. Two authors independently screened all the studies. Newcastle Ottawa Scale was used to assess the quality of the studies. The systematic review was carried following the PRISMA guidelines. Results After the rigorous process of screening, a total of 13 articles qualified for the systematic review. SBCT greater than 25 had sensitivity of greater than 80% in diagnosing myasthenia gravis exacerbation and SBCT less than or equal to 5 predicted the need for mechanical ventilation in Guillain-Barre syndrome (GBS) patients with 95.2% specificity. Also, Single breath count correlated significantly with forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) in children with pulmonary pathology and in patients with COVID-19 it was used to rule out the need for noninvasive respiratory support. Conclusion SBCT will undoubtedly be an asset in low resource settings and in tele-medicine to assess the prognosis and guide management of different respiratory and neuromuscular diseases.
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Affiliation(s)
| | - Anil Bist
- Tribhuvan University Institute of Medicine, Maharajgunj Medical Campus, Internal Medicine, Maharajgunj, Nepal
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Savic-Pesic D, Chamorro N, Lopez-Rodriguez V, Daniel-Diez J, Torres Creixenti A, El Mesnaoui MI, Benavides Navas VK, Castellanos Cotte JD, Abellan Cano I, Da Costa Azevedo FA, Trenza Peñas M, Voelcker-Sala I, Villalobos F, Satue-Gracia EM, Martin-Lujan F. Validity of the Espiro Mobile Application in the Interpretation of Spirometric Patterns: An App Accuracy Study. Diagnostics (Basel) 2023; 14:29. [PMID: 38201338 PMCID: PMC10795716 DOI: 10.3390/diagnostics14010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (k). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8-99.9%) and 94.9% (95%CI: 87.4-98.6%) with pulmonologist 1 and 100% (95%CI: 91.6-100%) and 98.7% (95%CI: 92.9-99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than k 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than k 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation.
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Affiliation(s)
- Darinka Savic-Pesic
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
| | - Nuria Chamorro
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Vanesa Lopez-Rodriguez
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Jordi Daniel-Diez
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Anna Torres Creixenti
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Mohamed Issam El Mesnaoui
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Viviana Katherine Benavides Navas
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Jose David Castellanos Cotte
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Iván Abellan Cano
- Primary Care Unit, Sanitat Conselleria, Generalitat Valenciana, Dpto 18, Carretera de Sax s/n, 03600 Elda, Spain
| | | | - María Trenza Peñas
- Centro de Salud Aguilas Sur, Primary Care Unit, Servicio Murciano de Salud, Calle Rey Carlos III, s/n, 30880 Aguilas, Spain
| | - Iñaki Voelcker-Sala
- College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, SA 5042, Australia
| | - Felipe Villalobos
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
| | - Eva-María Satue-Gracia
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
| | - Francisco Martin-Lujan
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
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3
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Boesing M, Ottensarendt N, Lüthi-Corridori G, Leuppi JD. The Management of Acute Exacerbations in COPD: A Retrospective Observational Study and Clinical Audit. J Clin Med 2023; 13:19. [PMID: 38202025 PMCID: PMC10779377 DOI: 10.3390/jcm13010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are not only associated with increased patient morbidity and mortality, but with extensive healthcare costs. Thus, adequate clinical management is crucial. The aim of this project was to evaluate the management of acute COPD exacerbations in a public teaching hospital in Switzerland. (2) Methods: We retrospectively analyzed clinical routine data of patients presenting with an acute exacerbation of COPD at the emergency department of a Swiss hospital between January 2019 and February 2020. Management was evaluated against recommendations from the GOLD 2019 report and previous audits. (3) Results: The data of 184 patients (mean age 73.5 years, range 41-95 years, 53% male) with 226 visits were included. While the documentation of GOLD stage (I-IV) and smoking status was consistent (81.0% and 91.6%), GOLD risk category (A-D) was only documented in 36% of the cases. Patients' respiratory rate upon presentation was measured in 73%, and blood gas analysis was performed in 70%. A total of 94% of the patients received a chest imaging; spirometry was performed in 10%. Initial symptomatic therapy with short acting bronchodilators was applied in 56%. Systemic steroid treatment was installed in 86%. Antibiotics were given in 56%, but in one fourth the indication was not clear. Non-invasive ventilation was applied in 25% of the indicated cases. Smoking cessation was recommended to 26% of the current smokers and referral to pulmonary rehabilitation was given in 16%. (4) Conclusion: GOLD recommendations were not comprehensively implemented, especially with regard to the assessment of severity, initial symptomatic therapy, and non-invasive ventilation. These results show the importance of the frequent revision of routine practice and may help to create awareness among practitioners and ultimately improve the quality of COPD management.
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Affiliation(s)
- Maria Boesing
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Nicola Ottensarendt
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Giorgia Lüthi-Corridori
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Jörg D. Leuppi
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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4
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Pagano L, Dennis S, Wootton S, Mahadev S, Chan ASL, Zwar N, Pallavicini D, McKeough Z. Identifying airway obstruction in primary care: is there a role for physiotherapists? BMC PRIMARY CARE 2022; 23:324. [PMCID: PMC9748384 DOI: 10.1186/s12875-022-01944-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Aims
To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.
Methods
Four general practices were recruited. ‘At risk’ participants (aged ≥ 40 years, current/ex-smoker) and people with ‘existing’ COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV1/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.
Results
One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 ‘at risk’, 31’existing’ COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of ‘at risk’ and 77% (24/31) of ‘existing’ COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV1 were classified as A (68%), B (19%) and C (5%).
Conclusion
Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding ‘at risk’ patients and identifying potential misdiagnosis of obstruction in some ‘existing’ COPD cases.
Trial registration
ANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx
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5
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Chen S, Li X, Wang Z, Zhou Y, Zhao D, Zhao Z, Liu S, Ran P. Validity of the Handheld Expiratory Flowmeter for COPD Screening in the Primary Care Setting of China. Int J Chron Obstruct Pulmon Dis 2021; 16:2039-2047. [PMID: 34267511 PMCID: PMC8275149 DOI: 10.2147/copd.s312190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flowmeter (Vitalograph Ltd., COPD-6®, Ireland) for COPD screening in Chinese primary care settings. Methods In our cross-sectional study, subjects were randomly selected in eight primary care settings. Tests with the handheld expiratory flowmeter and the conventional spirometry were sequentially performed on all participants. The correlation between the handheld expiratory flowmeter and the conventional spirometry was determined. Validity was determined by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1)/forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points. Results A total of 229 subjects (15.4%) were diagnosed with airflow limitation by conventional spirometry. FEV1, FEV6, and FEV1/FEV6 measured by the handheld expiratory flowmeter were correlated with FEV1, FVC, and FEV1/FVC measured by the conventional spirometry (r=0.889, 0.835 and 0.647, p<0.001), respectively. AUC of the FEV1/FEV6 to determine airflow obstruction was 0.857 (95% CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic group (AUC=0.869 vs 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs 0.840; P=0.515). The cut-off point for FEV1/FEV6 was 0.77 and the corresponding sensitivity and specificity were 71.2% and 89.8%, respectively. Conclusion The handheld expiratory flowmeter might be used as a screening device for COPD in Chinese primary care settings.
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Affiliation(s)
- Shuyun Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China.,Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Xiaochen Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China.,The People's Hospital of Hubei Province, Wuhan, Hubei Province, People's Republic of China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhuxiang Zhao
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China.,The First People's Hospital of Guangzhou City, Guangzhou, Guangdong Province, People's Republic of China
| | - Sha Liu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Jankowski P, Górska K, Mycroft K, Korczyński P, Soliński M, Kołtowski Ł, Krenke R. The use of a mobile spirometry with a feedback quality assessment in primary care setting - A nationwide cross-sectional feasibility study. Respir Med 2021; 184:106472. [PMID: 34049155 DOI: 10.1016/j.rmed.2021.106472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mobile phone-linked portable spirometers are light-weight, easy to use and low cost, with new software to facilitate data collection. In this study we investigated the feasibility of the AioCare® mobile spirometry in primary care. METHODS In this nationwide, cross-sectional study, AioCare® spirometers (HealthUp, Poland) were distributed among primary healthcare centres across Poland. Operators (primary care professionals) received a 2-h training session, after which spirometry was performed in patients attending routine visits with respiratory symptoms or risk factors for obstructive airway diseases. Spirometry was considered technically correct when at least three manoeuvres met ERS/ATS acceptability and repeatability criteria. The most common spirometry errors were assessed and stepwise logistic regression was applied to identify factors associated with technically correct spirometry. Airway obstruction was defined as FEV1/FVC below the lower limit of normal. A restrictive pattern was defined as FVC below the lower limit of normal. RESULTS Between 1 September 2018 and 1 September 2019, 10,936 spirometry examinations were performed in 9855 patients by 673 operators. 5347 (49%) spirometry examinations met both acceptability and repeatability criteria. The most common error was plateau error (17.7%). Operator age >40 years (OR 1.49, 95% CI 1.35-1.64) and repetition of the examination at the same visit (OR 1.90, 95% CI 1.66-2.16) increased the likelihood of a technically correct examination. Airway obstruction was found in 17% of correctly performed spirometry examinations. CONCLUSIONS Our nationwide study suggests that use of the AioCare® mobile spirometer in primary care could be feasible. More intensive and continual training should be implemented to improve the quality of spirometry examinations.
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Affiliation(s)
- Piotr Jankowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Korczyński
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Soliński
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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Ivanova O, Khosa C, Bakuli A, Bhatt N, Massango I, Jani I, Saathoff E, Hoelscher M, Rachow A. Lung Function Testing and Prediction Equations in Adult Population from Maputo, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124535. [PMID: 32599726 PMCID: PMC7344554 DOI: 10.3390/ijerph17124535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Background: Local spirometric prediction equations are of great importance for interpreting lung function results and deciding on the management strategies for respiratory patients, yet available data from African countries are scarce. The aim of this study was to collect lung function data using spirometry in healthy adults living in Maputo, Mozambique and to derive first spirometric prediction equations for this population. Methods: We applied a cross-sectional study design. Participants, who met the inclusion criteria, underwent a short interview, anthropometric measurements, and lung function testing. Different modelling approaches were followed for generating new, Mozambican, prediction equations and for comparison with the Global Lung Initiative (GLI) and South African equations. The pulmonary function performance of participants was assessed against the different reference standards. Results: A total of 212 males and females were recruited, from whom 155 usable spirometry results were obtained. The mean age of participants was 35.20 years (SD 10.99) and 93 of 155 (59.35%) were females. The predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC ratio based on the Mozambican equations were lower than the South African—and the GLI-based predictions. Conclusions: This study provides first data on pulmonary function in healthy Mozambican adults and describes how they compare to GLI and South African reference values for spirometry.
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Affiliation(s)
- Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Correspondence:
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Isabel Massango
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
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8
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Mannino DM, Thomashow B. COUNTERPOINT: Can Screening for COPD Improve Outcomes? No. Chest 2020; 157:9-12. [DOI: 10.1016/j.chest.2019.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 10/25/2022] Open
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9
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Urwyler P, Boesing M, Abig K, Cattaneo M, Dieterle T, Zeller A, Bachler H, Markun S, Senn O, Merlo C, Essig S, Ullmer E, Rutishauser J, Schuurmans MM, Leuppi JD. Reduction of corticosteroid use in outpatient treatment of exacerbated COPD - Study protocol for a randomized, double-blind, non-inferiority study, (The RECUT-trial). Trials 2019; 20:727. [PMID: 31842993 PMCID: PMC6916452 DOI: 10.1186/s13063-019-3856-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major public health issue affecting approximately 4% to 7% of the Swiss population. According to current inpatient guidelines, systemic corticosteroids are important in the treatment of acute COPD exacerbations and should be given for 5 to 7 days. Several studies suggest that corticosteroids accelerate the recovery of FEV1 (forced expiratory volume in 1 second), enhance oxygenation, decrease the duration of hospitalization, and improve clinical outcomes. However, the additional therapeutic benefit regarding FEV1 recovery appears to be most apparent in the first 3 to 5 days. No data are available on the optimum duration of corticosteroid treatment in primary-care patients with acute COPD exacerbations. Given that many COPD patients are treated as outpatients, there is an urgent need to improve the evidence base on COPD management in this setting. The aim of this study is to investigate whether a 3-day treatment with orally administered corticosteroids is non-inferior to a 5-day treatment in acute exacerbations of COPD in a primary-care setting. Methods/design This study is a prospective double-blind randomized controlled trial conducted in a primary-care setting. It is anticipated that 470 patients with acutely exacerbated COPD will be recruited. Participants are randomized to receive systemic corticosteroid treatment of 40 mg prednisone daily for 5 days (conventional arm, n = 235) or for 3 days followed by 2 days of placebo (experimental arm, n = 235). Antibiotic treatment for 7 days is given to all patients with CRP ≥ 50 mg/l, those with a known diagnosis of bronchiectasis, or those presenting with Anthonisen type I exacerbation. Additional treatment after inclusion is left at the discretion of the treating general practitioner. Follow-up visits are performed on days 3 and 7, followed by telephone interviews on days 30, 90, and 180 after inclusion in the study. The primary endpoint is the time to next exacerbation during the 6-month follow-up period. Discussion The study is designed to assess whether a 3-day course of corticosteroid treatment is not inferior to the conventional 5-day treatment course in outpatients with exacerbated COPD regarding time to next exacerbation. Depending on the results, this trial may lead to a reduction in the cumulative corticosteroid dose in COPD patients. Trial registration ClinicalTrials.gov, NCT02386735. Registered on 12 March 2015.
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Affiliation(s)
- Pascal Urwyler
- University Department of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH - 4410, Liestal, Switzerland
| | - Maria Boesing
- University Department of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH - 4410, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH - 4056, Basel, Switzerland
| | - Kristin Abig
- University Department of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH - 4410, Liestal, Switzerland
| | - Marco Cattaneo
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, CH - 4031, Basel, Switzerland
| | - Thomas Dieterle
- University Department of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH - 4410, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH - 4056, Basel, Switzerland
| | - Andreas Zeller
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH - 4056, Basel, Switzerland.,Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH - 4410, Liestal, Switzerland
| | - Herbert Bachler
- Tyrolean Society of General Medicine, Innrain 71/2, A - 6020, Innsbruck, Austria.,Medical University of Innsbruck, Innrain 52, A - 6020, Innsbruck, Austria
| | - Stefan Markun
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, CH - 8091, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, CH - 8091, Zurich, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, CH - 6004, Luzern, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, CH - 6004, Luzern, Switzerland
| | - Elke Ullmer
- Centre for Lung Diseases Bern, Schaenzlistrasse 39, CH - 3013, Bern, Switzerland
| | - Jonas Rutishauser
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH - 4056, Basel, Switzerland.,Department of Medicine, Cantonal Hospital Baden, Im Ergel 1, CH - 5404, Baden, Switzerland
| | - Macé M Schuurmans
- Department of Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, CH - 8401, Winterthur, Switzerland
| | - Joerg Daniel Leuppi
- University Department of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH - 4410, Liestal, Switzerland. .,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH - 4056, Basel, Switzerland.
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10
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Grischott T, Falcato L, Senn O, Puhan MA, Bruggmann P. Chronic obstructive pulmonary disease (COPD) among opioid-dependent patients in agonist treatment. A diagnostic study. Addiction 2019; 114:868-876. [PMID: 30675957 DOI: 10.1111/add.14559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/08/2018] [Accepted: 01/14/2019] [Indexed: 01/14/2023]
Abstract
AIMS To estimate the prevalence of chronic obstructive pulmonary disease (COPD) and related risk factors in people in opioid agonist treatment (OAT), to compare airflow limitation severity and age-specific COPD prevalence rates with those in the general population, and to assess the OAT patients' willingness to adopt life-style changes and to use therapeutic offers for COPD management. DESIGN Cross-sectional study in a random sample of OAT patients. SETTING Out-patient centres for substance addiction medicine in Zurich, Switzerland. PARTICIPANTS A total of 125 participants, recruited from November 2016 to April 2017 through invitation letters followed by phone or personal contact. MEASUREMENTS Standardized questionnaires about drug use, smoking habits and medical history, completed during face-to-face interviews or from medical records. Spirometry without and-depending on the result-with bronchodilation. FINDINGS Almost one-third [30.3%; 95% confidence interval (CI) = 22.6-39.0%] of the 119 participants with valid spirometry tests were diagnosed with COPD. Among males aged 30-59 years, the age-adjusted prevalence of at least moderate airflow limitation (GOLD grade ≥ 2) was 2.4 (95% CI = 1.3-4.4) times as high as in the ever-smoking Swiss population in the same age group. Smoking tobacco (92.0%) and substance inhalation (cannabis = 97.6%, cocaine = 69.6%, heroin = 68.0%) were highly prevalent among all participants. The participants expressed considerable interest in life-style changes and use of therapeutic offers for COPD management, with smoking cessation being least (20.2% of tobacco smokers interested) and pharmacological treatment to alleviate COPD symptoms most popular. CONCLUSIONS In Switzerland, COPD prevalence and multiple risk factors for COPD appear to be high among people in OAT compared with the general population. Individuals in OAT appear to develop COPD at a younger average age compared with the general population and are open to life-style changes and other COPD management approaches.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland
| | - Luis Falcato
- Arud Centre for Addiction Medicine, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Philip Bruggmann
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland.,Arud Centre for Addiction Medicine, Zurich, Switzerland
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11
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Topalovic M, Das N, Burgel PR, Daenen M, Derom E, Haenebalcke C, Janssen R, Kerstjens HAM, Liistro G, Louis R, Ninane V, Pison C, Schlesser M, Vercauter P, Vogelmeier CF, Wouters E, Wynants J, Janssens W. Artificial intelligence outperforms pulmonologists in the interpretation of pulmonary function tests. Eur Respir J 2019; 53:13993003.01660-2018. [PMID: 30765505 DOI: 10.1183/13993003.01660-2018] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
The interpretation of pulmonary function tests (PFTs) to diagnose respiratory diseases is built on expert opinion that relies on the recognition of patterns and the clinical context for detection of specific diseases. In this study, we aimed to explore the accuracy and interrater variability of pulmonologists when interpreting PFTs compared with artificial intelligence (AI)-based software that was developed and validated in more than 1500 historical patient cases.120 pulmonologists from 16 European hospitals evaluated 50 cases with PFT and clinical information, resulting in 6000 independent interpretations. The AI software examined the same data. American Thoracic Society/European Respiratory Society guidelines were used as the gold standard for PFT pattern interpretation. The gold standard for diagnosis was derived from clinical history, PFT and all additional tests.The pattern recognition of PFTs by pulmonologists (senior 73%, junior 27%) matched the guidelines in 74.4±5.9% of the cases (range 56-88%). The interrater variability of κ=0.67 pointed to a common agreement. Pulmonologists made correct diagnoses in 44.6±8.7% of the cases (range 24-62%) with a large interrater variability (κ=0.35). The AI-based software perfectly matched the PFT pattern interpretations (100%) and assigned a correct diagnosis in 82% of all cases (p<0.0001 for both measures).The interpretation of PFTs by pulmonologists leads to marked variations and errors. AI-based software provides more accurate interpretations and may serve as a powerful decision support tool to improve clinical practice.
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Affiliation(s)
- Marko Topalovic
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Nilakash Das
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Pierre-Régis Burgel
- Cochin Hospital, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Daenen
- Dept of Respiratory Medicine, Hospital Oost-Limburg, Genk, Belgium
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Rob Janssen
- Dept of Pulmonary Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Huib A M Kerstjens
- Dept of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Liistro
- Dept of Pneumology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Renaud Louis
- Dept of Respiratory Medicine, University Hospital, Liege, Belgium
| | - Vincent Ninane
- Dept of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Pison
- Service Hospitalier Universitaire de Pneumologie et Physiologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Marc Schlesser
- Dept of Pulmonary Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Piet Vercauter
- Dept of Respiratory Medicine, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Emiel Wouters
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jokke Wynants
- Dept of Pneumology, Jessa Hospital, Hasselt, Belgium.,For a full list of Pulmonary Function Study Investigators, please refer to the Acknowledgements section
| | - Wim Janssens
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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12
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Urwyler P, Abu Hussein N, Bridevaux PO, Chhajed PN, Geiser T, Grendelmeier P, Joos Zellweger L, Kohler M, Maier S, Miedinger D, Tamm M, Thurnheer R, Dieterle T, Leuppi JD. Predictive factors for exacerbation and re-exacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort. Multidiscip Respir Med 2019; 14:7. [PMID: 30774953 PMCID: PMC6364405 DOI: 10.1186/s40248-019-0168-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).
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Affiliation(s)
- Pascal Urwyler
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Nebal Abu Hussein
- 2University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Pierre O Bridevaux
- 3Hospital of Valais, University of Geneva, Avenue du Grand-Champsec 80, 1950 Sion, Switzerland
| | - Prashant N Chhajed
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Thomas Geiser
- 4University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Grendelmeier
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Ladina Joos Zellweger
- 5St. Clara Hospital, University of Basel, Kleinriehenstrasse 30, 4002 Basel, Switzerland
| | - Malcolm Kohler
- 6University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Sabrina Maier
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - David Miedinger
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Michael Tamm
- 2University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Robert Thurnheer
- Cantonal Hospital of Muensterlingen, Spitalcampus 1, 8596 Münsterlingen, Switzerland
| | - Thomas Dieterle
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Joerg D Leuppi
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
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13
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Comparison of spirometric results obtained from the sitting and standing position in children participating in an epidemiological study. Postepy Dermatol Alergol 2018; 35:314-316. [PMID: 30008652 PMCID: PMC6041712 DOI: 10.5114/ada.2018.75434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction It is recommended that spirometric testing in children be completed while sitting. Our experience indicates that children prefer standing during spirometry. Aim We sought to compare spirometric results obtained from the sitting (SIP) and standing (STP) positions. Material and methods Two testing sessions were performed in random order (SIP vs. STP: 30–45 min apart) in 118 children (7–13 years), attending one, randomly selected, primary school (response rate: 92%). Results Acceptable quality was found in 77.9% of STP and 77.1% of SIP maneuvers. Higher values of spirometric variables on STP, compared to SIP, were obtained for forced vital capacity (FVC) (2.12 ±0.41 l vs. 2.11 ±0.39 l) and forced expiratory volume in 1 s (FEV1) (1.78 ±0.36 l vs. 1.77 ±0.35 l) but the differences were not statistically significant. Relative between-position differences (RBPD) ≤ 5% were found with the following frequencies: FVC: 56.4%, FEV1: 69.2%, PEF: 21.7%, and FEF25–75: 24.3%. Similar patterns were found for FEF25, FEF50, and FEF75. Relative between-position differences were related to age in the case of FEV1 (p = 0.005), FEF25 (p = 0.02), and FEF25–75 (p = 0.01) where older children had smaller RBPD. Forced vital capacity RBPD was lower (p = 0.01) in subjects with current wheeze; PEF RBPD were lower (p = 0.02) in children with asthma. Conclusions In epidemiological studies, the position of spirometric testing does not affect the results of lung function assessment.
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14
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de Pina DR, Alvarez M, Giacomini G, Pavan ALM, Guedes CIA, Cavalcante RDS, Mendes RP, Paniago AMM. Paracoccidioidomycosis: level of pulmonary sequelae in high resolution computed tomography images from patients of two endemic regions of Brazil. Quant Imaging Med Surg 2017; 7:318-325. [PMID: 28811998 DOI: 10.21037/qims.2017.06.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of the present study was to evaluate differences in lung damage in patients with paracoccidioidomycosis (PCM) in two endemic regions of Brazil (Botucatu, SP, in the southeastern region and Campo Grande, MS, in the west central region). METHODS The study sought to objectively quantify fibrosis and emphysema treated patients using high-resolution computed tomography (HRCT) that was performed according to an established and validated computational method. The analysis was based on clinical data that were associated with objective quantifications of pulmonary sequelae. We performed a retrospective analysis of HRCT exams from 32 successfully treated patients with the chronic form of PCM. The two groups had similar characteristics with regard to age, symptom duration, smoking history, and titers on a diagnostic serologic test. RESULTS The statistical analysis revealed more severe cases and a higher percentage of emphysema in the Campo Grande group. The mean percentages of emphysema were 40.2% and 13.6% in the Campo Grande and Botucatu groups, respectively. The percentage of fibrosis was significantly higher in the Botucatu group (11.3%) than in the Campo Grande group (2.3%). CONCLUSIONS The present results may reflect differences in cryptic species of P. brasiliensis in these two geographic regions of Brazil. Further studies should be done to clarify the differences observed herein. Such findings may help unveil differences among cryptic species in terms of the pulmonary consequences that are caused by this disease, which would be highly beneficial to PCM patients.
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Affiliation(s)
- Diana Rodrigues de Pina
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Matheus Alvarez
- Department of Physics and Biophysics, Biosciences Institute of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Guilherme Giacomini
- Department of Physics and Biophysics, Biosciences Institute of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Ana Luiza Menegatti Pavan
- Department of Physics and Biophysics, Biosciences Institute of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Carlos Ivan Andrade Guedes
- Department of Internal Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Rinaldo Poncio Mendes
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Department of Internal Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
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15
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Chambers D, Booth A, Baxter SK, Johnson M, Dickinson KC, Goyder EC. Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine C Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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16
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Predictors of Increased Daytime Sleepiness in Patients with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study. SLEEP DISORDERS 2016; 2016:1089196. [PMID: 27822390 PMCID: PMC5086390 DOI: 10.1155/2016/1089196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022]
Abstract
Background. Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from increased daytime sleepiness. The aim of this study was to identify potential predictors of subjective daytime sleepiness with special regard to sleep-related breathing disorder and nocturnal activity. Methods. COPD patients were recruited at the University Hospital Basel, Switzerland. COPD risk groups A-D were determined according to spirometry and COPD Assessment Test (CAT). Breathing disorder evaluation was performed with the ApneaLink device. Nocturnal energy expenditure was measured with the SenseWear Mini Armband. Subjective daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS). Results. Twenty-two patients (36%) were in COPD risk group A, 28 patients (45%) in risk group B, and 12 patients (19%) in risk groups C + D (n = 62). Eleven patients (18%) had a pathological ESS ≥ 10/24. ESS correlated positively with CAT (r = 0.386, p < 0.01) and inversely with age (r = -0.347, p < 0.01). In multiple linear regression age (β = -0.254, p < 0.05), AHI (β = 0.287, p < 0.05) and CAT score (β = 0.380, p < 0.01) were independent predictors of ESS, while nocturnal energy expenditure showed no significant association (p = 0.619). Conclusion. These findings provide evidence that daytime sleepiness in COPD patients may partly be attributable to nocturnal respiratory disturbances and it seems to mostly affect younger patients with more severe COPD symptoms.
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Labor M, Vrbica Ž, Gudelj I, Labor S, Plavec D. Diagnostic accuracy of a pocket screening spirometer in diagnosing chronic obstructive pulmonary disease in general practice: a cross sectional validation study using tertiary care as a reference. BMC FAMILY PRACTICE 2016; 17:112. [PMID: 27542843 PMCID: PMC4992327 DOI: 10.1186/s12875-016-0518-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND COPD-6™ is a lung function testing device for a rapid pre-spirometry testing to screen-out at-risk individuals not having COPD and indicating those at risk. The aim of this study was to validate COPD-6™ lung function testing (index test) in general practice in discriminating patients with COPD out of the population at risk - smokers/ex-smokers with no previous diagnosis of COPD, using measurements at tertiary care as reference standard. METHODS Consecutive 227 subjects (115 women, 185 smokers/42 ex-smokers, ≥20 pack-years) with no previous diagnosis of COPD, aged 52.5 (SD 6.8) years from 26 general practitioners (GPs) were recruited, lung function tested with COPD-6™, referred to the tertiary institution for repeated COPD-6™ testing followed by spirometry with a bronchodilator (salbutamol), examination, and pulmonologist consultation for the diagnosis and severity of COPD. RESULTS COPD was diagnosed in 43 subjects (18.9 %), with an AUC of 0.827 (95 % CI 0.769-0.875, P < 0.001) for the diagnosis of COPD when lung function was measured using COPD-6™ in GP's office with a specificity of 100 % (95 % CI, 97.95-100 %) but a very low sensitivity of 32.56 % (95 % CI, 20.49-47.48 %). Significant agreement for forced expiratory volume in 1 s measured at GP's office and at lung function lab was found (mean difference 0.01 L, p = 0.667) but not for other measured parameters (p < 0.001 for all). CONCLUSIONS Our study results point out that active case finding in a population at risk for COPD should be instituted (almost 20 % of undiagnosed COPD). Based on our results lung function testing with COPD-6™ can substitute spirometry testing in cases where it is not readily available to the patient/physician taken into account that the traditional FEV1/FEV6 cutoff value of <0.7 is not the only criterion for diagnosis and/or further referral. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01550679 Registered 28 September 2014, retrospectively registered.
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Affiliation(s)
- Marina Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Žarko Vrbica
- Department of Pulmonology an Immunology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik, Croatia
- University of Dubrovnik, Branitelja Dubrovnika 29, Dubrovnik, Croatia
| | - Ivan Gudelj
- Department of Pulmonology, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Slavica Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Davor Plavec
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
- Research Department, Children’s Hospital Srebrnjak, Srebrnjak 100, Zagreb, Croatia
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Haroon SM, Jordan RE, O'Beirne-Elliman J, Adab P. Effectiveness of case finding strategies for COPD in primary care: a systematic review and meta-analysis. NPJ Prim Care Respir Med 2015; 25:15056. [PMID: 26313400 PMCID: PMC4551096 DOI: 10.1038/npjpcrm.2015.56] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/14/2015] [Accepted: 07/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown. Aims: The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care. Methods: A systematic review of primary studies of any design evaluating case finding strategies for COPD in primary care among individuals aged ⩾35 years with no prior diagnosis was conducted. Medline, Embase and other bibliographic databases were searched from 1997 to 2013, and methodological quality was assessed using standard tools. Results were described and meta-analysis of the uptake and yield from different approaches was performed where there was sufficient homogeneity. Results: Three randomised controlled trials (RCTs), 1 controlled trial and 35 uncontrolled studies were identified that assessed the identification of new cases of COPD through systematic case finding. A range of approaches were used including pre-screening with questionnaires (n=13) or handheld flow meters (n=5) or direct invitation to diagnostic spirometry (n=30). Overall, any approach identified more undiagnosed COPD compared with usual care. Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) is likely to increase the yield. However, studies were heterogeneous and were limited by a lack of comparison groups, inadequate reporting and diversity in the definition of COPD, which limited our ability to draw firm conclusions. Conclusions: There is extensive heterogeneity among studies evaluating case finding strategies for COPD, with few RCTs. Well-conducted RCTs comparing case finding approaches are needed to identify the most effective target population, recruitment strategy and screening tests, using a clinical definition of COPD, and addressing the limitations highlighted in this review. There is also a need to evaluate the impact of case finding on clinical care and patient outcomes.
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Affiliation(s)
- Shamil Mm Haroon
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel E Jordan
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Joanne O'Beirne-Elliman
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peymane Adab
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry. Am J Med 2015; 128:629-37. [PMID: 25595469 DOI: 10.1016/j.amjmed.2014.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Primary care physicians often do not use spirometry to confirm the diagnosis of chronic obstructive pulmonary disease. This project was designed to see how well physicians' impressions about their patients' chronic obstructive pulmonary disease severity correlate with the severity of airflow obstruction measured by spirometry and to assess whether spirometry results subsequently changed the physicians' opinions about chronic obstructive pulmonary disease severity and treatment. METHODS We performed a multicenter, cross-sectional, observational study conducted in 83 primary care clinics from across the United States. A total of 899 patients with a clinical diagnosis of chronic obstructive pulmonary disease completed a questionnaire and spirometry testing. Physicians completed a questionnaire and case report forms. Concordance among physician ratings, patient ratings, and spirometry results was evaluated. RESULTS Physicians' chronic obstructive pulmonary disease severity ratings before spirometry were accurate for only 30% of patients with evaluable spirometry results, and disease severity in 41% of patients was underestimated. Physicians also underestimated severity compared with patients' self-assessment among 42% of those with evaluable results. After spirometry, physicians changed their opinions on the severity for 30% of patients and recommended treatment changes for 37%. Only 75% of patients performed at least 1 high-quality spirometry test; however, the physicians' opinions and treatment decisions were similar regardless of suboptimal test results. CONCLUSIONS Without performing spirometry, physicians are likely to underestimate their patients' chronic obstructive pulmonary disease severity or inadequately characterize their patients' lung disease. Spirometry changed the physicians' clinical impressions and treatments for approximately one third of these patients; thus, spirometry is a valuable tool for chronic obstructive pulmonary disease management in primary care.
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Tan WC, Bourbeau J, O'Donnell D, Aaron S, Maltais F, Marciniuk D, Hernandez P, Cowie R, Chapman K, Sonia Buist A, Sin D, Mark Fitzgerald J. Quality assurance of spirometry in a population-based study -predictors of good outcome in spirometry testing. COPD 2014; 11:143-51. [PMID: 24666210 DOI: 10.3109/15412555.2013.822857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The assurance of high-quality spirometry testing remains a challenge. METHODS Spirometry training consisted of standardized coaching followed by certification for 35 spirometry-naïve and 9 spirometry-experienced research assistants. Spirometry was performed before and after bronchodilator (BD) in random population samples of 5176 people aged 40 years and older from 9 sites in Canada. using the hand-held EasyOne spirometer (ndd Medical Technologies Inc., Andover, MA, USA). Pulmonary function quality assurance with over reading was conducted centrally in Vancouver: spirograms were reviewed and graded according to ATS/ERS standards with prompt feedback to the technician at each site. Descriptive statistics were calculated for manoeuvre acceptability and repeatability variables. A logistic regression model was constructed for the predictors of spirometry quality success. RESULTS 95% of test sessions achieved pre-determined quality standards for back extrapolated volume (BEV), time to peak flow (PEFT) and end of test volume (EOTV). The mean forced expiratory time (FET) was 11.2 seconds. Then, 90% and 95% of all manoeuvres had FEV1 and FVC that were repeatable within 150 ml and 200 ml respectively. Test quality was slightly better for post-BD test sessions compared with pre-BD for both groups of research assistants. Independent predictors of acceptable test quality included participant characteristics: female sex, younger age, greater BD responsiveness; but not study site or prior experience in completing spirometry by the technologist. CONCLUSIONS Good quality spirometry tests are attainable in large multicenter epidemiological studies by trained research assistants, irrespective of their prior experience in spirometry.
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Affiliation(s)
- Wan C Tan
- 1UBC James Hogg Research Laboratories, Providence Heart + Lung Institute, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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21
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Lemoigne F, Barré E, Arsento M, Bily F, Gibelin G, Pelser M, Paillasseur JL, Garcia-Macé J, Perez T, Roche N. [Early detection of COPD in occupational medicine in the Alpes-Maritimes]. Rev Mal Respir 2014; 32:30-7. [PMID: 25618202 DOI: 10.1016/j.rmr.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 01/06/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study evaluated a standardized procedure aiming at early detection of COPD in a consecutive population of employees visiting occupational medicine. METHODS A total of 2818 employees were included by 22 occupational physicians in 5 centers. Respiratory symptoms, smoking status, occupational exposures and socioprofessional categories were collected. Subjects with at least one symptom and/or risk factor underwent spirometry. RESULTS In this population aged 39±12 years, 2603 patients were free of known asthma or COPD. The presence of at least one symptom was observed in 23.6 % of employees and was significantly associated with smoking status, occupational exposure to organic dust, gas fumes and vapors, and agriculture (P<0.0001). Airflow obstruction (FEV1/FVC < 0.70) was detected in 1.7 % of 1605 employees who underwent spirometry. With the inclusion of known COPD subjects (n=22), the prevalence reached 2.38 %. COPD was significantly associated with smoking intensity. Information on subsequent diagnosis was obtained in only two cases. The quality of spirometry was inadequate in 30 % of cases. Thirty-three percent of detected COPD subjects did not report any respiratory symptoms. CONCLUSION The strategy used in this study (specific questionnaire plus spirometry) allowed detection of a few cases of previously undiagnosed COPD. Occupational physicians need specific training in spirometry and a better follow-up of care pathways is required to obtain diagnostic confirmation.
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Affiliation(s)
- F Lemoigne
- Service de pneumologie, hôpital Pasteur, 30, voie Romaine, BP 69, 06002 Nice cedex, France.
| | - E Barré
- AMETRA 06, service de santé au travail des Alpes-Maritimes, 06560 Sophia Antipolis, France
| | - M Arsento
- Association du service médical de l'aromatique (ASMAROM), 06130 Grasse, France
| | - F Bily
- Centre de gestion de la fonction publique territoriale (CG-FT), 06704 Saint-Laurent-du-Var, France
| | - G Gibelin
- Mutualité sociale agricole (MSA), 06200 Nice, France
| | - M Pelser
- Association paritaire de santé au travail BTP 06 (APST BTP 06), 06000 Nice, France
| | | | - J Garcia-Macé
- JGM Health Conseils, 95240 Cormeilles-en-Parisis, France
| | - T Perez
- Pneumologie, CHRU de Lille, 59000 Lille, France
| | - N Roche
- Service de pneumologie et des soins intensifs respiratoires, hôpital Cochin, site Val-de-Grâce, AP-HP, université Paris Descartes, 75679 Paris, France
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Marina Malanda N, López de Santa María E, Gutiérrez A, Bayón JC, Garcia L, Gáldiz JB. Telemedicine spirometry training and quality assurance program in primary care centers of a public health system. Telemed J E Health 2014; 20:388-92. [PMID: 24476193 DOI: 10.1089/tmj.2013.0111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. MATERIALS AND METHODS The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). RESULTS In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (p<0.001). In the second phase, 7,200 spirometry tests were assessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; p<0.001). CONCLUSIONS (1) The quality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.
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Affiliation(s)
- Nuria Marina Malanda
- 1 Respiratory Function Laboratory, Department of Pulmonology, Cruces University Hospital , Barakaldo, Bizkaia, Spain
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Gochicoa-Rangel L, Vargas-Domínguez C, García-Mujica ME, Bautista-Bernal A, Salas-Escamilla I, Pérez-Padilla R, Torre-Bouscoulet L. Quality of spirometry in 5-to-8-year-old children. Pediatr Pulmonol 2013; 48:1231-6. [PMID: 23401425 DOI: 10.1002/ppul.22765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/28/2012] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Although spirometry quality standards for children were proposed by American Thoracic Society/European Respiratory Society (ATS/ERS) in 2007, there is limited information on the percentage of children that fulfill these criteria during routine clinical testing, especially among 5-to-8-year-olds. AIMS OF THE STUDY to report the percentage of children that met the current 2007 ATS/ERS quality criteria; explore factors potentially associated with poor quality spirometry; and ascertain the repeatability of forced expiratory volume at 0.5 sec (FEV0.5 ), and at 1 sec (FEV1 ), as well as forced vital capacity (FVC). METHODS We evaluated the quality of spirometries without bronchodilator use performed at our laboratory in 2008 by 5-to-8-year-old children. FEV1 , FEV0.5 , FVC, back-extrapolated volume (BEV), forced expiratory time (FET), number of acceptable maneuvers, and repeatability, were computed and the percentage of tests that met the quality criteria standards was calculated. Based on our results, we propose a quality scoring system for spirometry for children that grades on a scale from A-to-F. RESULTS Three hundred seventy-six spirometries were reviewed. Mean age was 6.7 years; (53% males); 68% fulfilled the 2005 and 2007 ATS/ERS quality standards; >90% reached a repeatability ≤150 and ≤100 ml, or 10%, in FVC or FEV1 ; 87.2% reached FET ≥3 sec; 88% had a BEV ≤80 ml. The 90 percentile repeatability was 120 ml for FVC and FEV1 . Quality improved with age. CONCLUSIONS Our results support the proposal that a FET ≥3 sec, a BEV ≤80 ml, and repeatability in FEV1 and FVC ≤100 ml, or 10%, be taken into account as elements in quality control for spirometry in children.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., Mexico
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Weiss G, Steinacher I, Lamprecht B, Schirnhofer L, Kaiser B, Sönnichsen A, Studnicka M. Detection of chronic obstructive pulmonary disease in primary care in Salzburg, Austria: findings from the real world. ACTA ACUST UNITED AC 2013; 87:136-43. [PMID: 24296512 DOI: 10.1159/000354796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. OBJECTIVES To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. METHODS The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. RESULTS 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). CONCLUSION COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
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Kart L, Akkoyunlu ME, Bayram M, Yakar F, Kutbay Özçelik H, Karaköse F, Sezer M. COPD: an underdiagnosed disease at hospital environment. Wien Klin Wochenschr 2013; 126:73-8. [PMID: 24249327 DOI: 10.1007/s00508-013-0458-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area. MATERIAL AND METHODS People who came to the hospital for patient visit or examination with a smoking history of > 10 pack-years (> 40 years old), and with no known chest disease were invited to study. The participants completed a questionnaire and performed spirometry. Spirometry was performed according to ATS/ERS Task Force on spirometry. COPD was defined as according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS There were 800 subjects screened, and 648, capable of performing spirometry, were included to the study. The mean age was 48.3 ± 9.0 and 38 % of the study population was male. Post-bronchodilator FEV1/FVC ratio was lower than 0.70 in 17 % of the subjects. Median (25-75 percentiles) total CAT scores and among the questions of CAT; cough, phlegm, chest tightness and breathlessness scores for COPD and non-COPD subjects were; 15(9-22) vs 12(6-18) (p = .004), 2(1-3) vs 1(0-2) (p < .001), 2(0-3) vs 1(0-3) (p = .004), 3(1-4) vs 2(0-3) (p > .001), 4(3-5) vs 3(2-4) (p = .001), respectively. Symptom prevalence was as follows: exertional dyspnea 91 %, dyspnea 80.9 %, cough 56.3 % and phlegm 58.3 % in COPD. CONCLUSION Our study showed that spirometric screening together with the CAT questionnaire may improve the awareness of disease and may determine undiagnosed patients.
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Affiliation(s)
- Levent Kart
- Department of Pulmonary Medicine, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
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Enright P, Schermer T. Don't pay for poor quality spirometry tests. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:15-6. [PMID: 23443224 PMCID: PMC6442761 DOI: 10.4104/pcrj.2013.00023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paul Enright
- Professor of Medicine (retired), College of Public Health and Department of Medicine, The University of Arizona, Tucson, AZ, USA
- College of Public Health and Department of Medicine, The University of Arizona, Post office box 675, Mount Lemmon, Tucson, AZ, USA Tel: +520 576 1030 E-mail:
| | - Tjard Schermer
- Associate Professor and Director, COPD & Asthma Research & Development Unit, Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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Russi EW, Karrer W, Brutsche M, Eich C, Fitting JW, Frey M, Geiser T, Kuhn M, Nicod L, Quadri F, Rochat T, Steurer-Stey C, Stolz D. Diagnosis and management of chronic obstructive pulmonary disease: the Swiss guidelines. Official guidelines of the Swiss Respiratory Society. ACTA ACUST UNITED AC 2013; 85:160-74. [PMID: 23406723 DOI: 10.1159/000346025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/21/2012] [Indexed: 02/05/2023]
Abstract
The new Swiss Chronic Obstructive Pulmonary Disease (COPD) Guidelines are based on a previous version, which was published 10 years ago. The Swiss Respiratory Society felt the need to update the previous document due to new knowledge and novel therapeutic developments about this prevalent and important disease. The recommendations and statements are based on the available literature, on other national guidelines and, in particular, on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. Our aim is to advise pulmonary physicians, general practitioners and other health care workers on the early detection and diagnosis, prevention, best symptomatic control, and avoidance of COPD as well as its complications and deterioration.
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Affiliation(s)
- E W Russi
- Pulmonary Division, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
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Nelson SB, LaVange LM, Nie Y, Walsh JW, Enright PL, Martinez FJ, Mannino DM, Thomashow BM. Questionnaires and pocket spirometers provide an alternative approach for COPD screening in the general population. Chest 2012; 142:358-366. [PMID: 22194590 DOI: 10.1378/chest.11-1474] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In response to the Agency for Healthcare Research and Quality statement questioning the usefulness of “screening spirometry,” the National Heart, Lung, and Blood Institute and the COPD Foundation held a consensus conference in June 2008 to establish a procedure to detect cases of COPD in the general population. Conference participants developed a three-stage approach, using a brief questionnaire, peak flow measurement with a pocket spirometer, and diagnostic quality spirometry. The overall objective of this study was to examine the usefulness of a simple questionnaire and peak flow measurement in screening for COPD in a self-selected population. We hypothesized that this combination would efficiently screen for clinically relevant COPD. METHODS We queried individuals attending public events regarding the presence of wheeze and/or asthma, mucus production, dyspnea, exposure to irritants, and tobacco use. Peak expiratory flow (PEF) was then measured with a pocket spirometer. If PEF was < 70% predicted, spirometry was performed. In order to estimate the false-negative rate, a random sample of every 10th participant was also selected for spirometry. RESULTS Between June 2008 and December 2009, 5,761 adults completed the risk assessment questionnaire. The mean age of the respondents was 54 years, 58% were women, and 88% were white. Of these, 5,638 participants completed pocket spirometry, and 315 (5.6%) had PEF < 70% predicted. Of 5,323 with normal PEF, 651 underwent spirometry. The performance of PEF was assessed via positive and negative predictive values relative to a diagnosis of clinically significant airflow obstruction, defined as FEV(1)/FEV(6) < the lower limit of normal and FEV(1) < 60% predicted. Of 4,238 subjects with at least two risk factors, 267 (6.3%) had PEF < 70%, compared with 48 of the 1,400 subjects (3.4%) with fewer than two risk factors (P < .001). Based on 729 participants with acceptable spirometry, 63.1% (113 of 179) of those with abnormal PEF tested positive for clinically significant airflow obstruction, compared with 5.5% (30 of 550) with normal PEF (P < .001). The estimated prevalence of significant COPD among the 5,638 screened was 8.7%, and sensitivity and specificity were 40.7% and 97.7%, respectively. CONCLUSIONS A staged approach to COPD screening in adults is useful for detecting clinically significant airflow obstruction in our study population.
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Levy ML, Quanjer PH, Booker R, Holmes S, Small I. Standards for diagnostic spirometry within-session repeatability in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:252-3. [PMID: 22836738 PMCID: PMC6547960 DOI: 10.4104/pcrj.2012.00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 06/17/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Mark L Levy
- Senior Clinical Research Fellow, Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh; Editor Emeritus: Primary Care Respiratory Journal
| | - Philip H Quanjer
- Professor Emeritus of Physiology, Department of Pulmonary Diseases and Sophia Children's Hospital, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Rachel Booker
- Independent specialist respiratory nurse and freelance medical writer
| | - Steve Holmes
- General Practitioner, Shepton Mallet, Somerset, UK; Associate Dean (GP Medical Education) Severn Deanery, Bristol, UK; PCRS-UK Education Lead
| | - Iain Small
- General Practitioner, Peterhead Health Centre, Peterhead, Aberdeenshire, UK; Honorary Lecturer, Centre for Academic Primary Care, University of Aberdeen, UK; Chair of the PCRS-UK Executive Committee
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Guerin JC, Roche N, Vicaut É, Piperno D, Granet G, Jannin M, Deschamps F, Godard P. Sujets à risque de BPCO en médecine générale : comment favoriser la réalisation de spirométries et la détection précoce de l’obstruction bronchique ? Rev Mal Respir 2012; 29:889-97. [DOI: 10.1016/j.rmr.2012.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 03/11/2012] [Indexed: 10/28/2022]
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Kreiss K, Fedan KB, Nasrullah M, Kim TJ, Materna BL, Prudhomme JC, Enright PL. Longitudinal lung function declines among California flavoring manufacturing workers. Am J Ind Med 2012; 55:657-68. [PMID: 21932425 DOI: 10.1002/ajim.21013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The California Department of Public Health received serial spirometry data for flavoring manufacturing workers at 20 companies at risk of bronchiolitis obliterans. METHODS We graded spirometry quality; identified individual workers with excessive decline in forced expiratory volume in 1 s (FEV(1)) using relative longitudinal limits of decline based on 4% average within-person variability; and analyzed declines by occupational risk factors. RESULTS The quality of 1,696 spirometry tests from 724 workers varied by 17 providers, with poorer quality from commercial providers. Of 416 workers with at least two tests, 40 (9.6%) had abnormal FEV(1) decline. Of 289 workers with high quality spirometry, 21 (7.3%) had abnormal decline. Only one of the 21 had airways obstruction. Abnormal FEV(1) decline rates (per person-month) were greater among workers at companies using ≥800 lbs/year diacetyl than at companies using lesser amounts. Abnormal FEV(1) decline rates were greater at companies previously having four-person clusters of spirometric obstruction than at companies with no or only one worker with obstruction. CONCLUSIONS Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV(1) decline for preventive intervention, even when the FEV(1) itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work-related health effects.
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Affiliation(s)
- Kathleen Kreiss
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV 26505, USA.
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Latzke-Davis B, Stout J, Smith K, Solomon C, Garrison M, Mangione-Smith R. Effectiveness of Spirometry Fundamentals™ for increasing the proper use of spirometry in patients with asthma and COPD. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 20:441-7. [PMID: 21922125 DOI: 10.4104/pcrj.2011.00080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To examine whether exposure to the Spirometry Fundamentals™ CD-ROM results in improved quality of spirometry testing in primary care. METHODS Spirometry tests performed in 20 intervention and 19 control practices were analysed using American Thoracic Society grades A and B for 'passing' and grades C, D and F for 'failing'. Intervention effects on spirometry quality were assessed using random effects multivariate logistic regression. RESULTS Adjusted analyses revealed no intervention effect. The likelihood of passing tests was higher in paediatrics-only practices (adjusted odds ratio (AOR) 2.60, 95% confidence interval (CI) 1.32 to 5.12; p=0.01). Hospital or university-based clinics had a lower performance than private or community-based practices in unadjusted analysis (7% vs. 22% passing tests; p=0.05). However, this relationship was not significant in adjusted analyses. CONCLUSIONS Spirometry Fundamentals™ is insufficient to improve the quality of spirometry in primary care, suggesting the need for more comprehensive multifaceted training resources.
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Affiliation(s)
- Brooke Latzke-Davis
- Center for Child Health, Behavior and Development, Seattle Children's Hospital Research Institute, Seattle, Washington 98101, USA.
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Degryse J, Buffels J, Van Dijck Y, Decramer M, Nemery B. Accuracy of office spirometry performed by trained primary-care physicians using the MIR Spirobank hand-held spirometer. Respiration 2012; 83:543-52. [PMID: 22269344 DOI: 10.1159/000334907] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the availability of compact, portable, effective microspirometers, pulmonary function tests no longer need to be performed only in specialized laboratories. However, the perception persists that small flow-sensing devices are less accurate than volume-sensing spirometers. OBJECTIVES To study the accuracy of spirometry performed with the MIR Spirobank® and to investigate how accurately trained primary-care physicians can perform spirometry using a portable electronic spirometer. METHODS Patients with suspected occupational asthma were submitted to specific bronchial challenge tests in the pulmonary function laboratory according to published recommendations. Serial measurements were performed with the Jaeger MasterScope device (reference standard) or the Spirobank device. Data were generated from 908 parallel measurements on 34 patients. Furthermore, 16 patients with documented moderate to severe COPD were examined in a carousel set-up by four trained physicians who each used his/her own Spirobank device coupled to a laptop computer. RESULTS The Spirobank spirometer performed very well compared with the Jaeger MasterScope in a laboratory environment, displaying an underestimation of the forced expiratory volume in 1 s (FEV(1)) and FEV(1)/forced vital capacity (FVC) of 2-5%. High correlations were found for the pulmonary function parameters. The highest correlation was for FEV(1) (r(2) = 0.949) and the lowest for the maximum expiratory flow at 25% of FVC (MEF(25)) (r(2) = 0.864). Only 2% of the observed variation in the measurement results could be explained by the type of device. CONCLUSIONS The Spirobank device seems to be appropriate for research purposes if the standardized protocol is used correctly and the acceptability criteria are respected.
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Affiliation(s)
- J Degryse
- Department of Primary Health Care, KU Leuven, Leuven, Belgium.
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Schermer TRJ, Verweij EHA, Cretier R, Pellegrino A, Crockett AJ, Poels PJP. Accuracy and precision of desktop spirometers in general practices. Respiration 2012; 83:344-52. [PMID: 22236628 DOI: 10.1159/000334320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/10/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spirometry has become an essential tool for general practices to diagnose and monitor chronic airways diseases, but very little is known about the performance of the spirometry equipment that is being used in general practice settings. The use of invalid spirometry equipment may have consequences on disease diagnosis and management of patients. OBJECTIVES To establish the accuracy and precision of desktop spirometers that are routinely used in general practices. METHODS We evaluated a random sample of 50 spirometers from Dutch general practices by testing them on a certified waveform generator using 8 standard American Thoracic Society waveforms to determine accuracy and precision. Details about the brand and type of spirometers, year of purchase, frequency of use, cleaning and calibration were inquired with a study-specific questionnaire. RESULTS 39 devices (80%) were turbine spirometers, 8 (16%) were pneumotachographs, and 1 (2%) was a volume displacement spirometer. Mean age of the spirometers was 4.3 (SD 3.7) years. Average deviation from the waveform generator reference values (accuracy) was 25 ml (95% confidence interval 12-39 ml) for FEV(1) and 27 ml (10-45 ml) for FVC, but some devices showed substantial deviations. FEV(1) deviations were larger for pneumotachographs than for turbine spirometers (p < 0.0031), but FVC deviations did not differ between the two types of spirometers. In the subset of turbine spirometers, no association between age and device performance was observed. CONCLUSIONS On average, desktop spirometers in general practices slightly overestimated FEV(1) and FVC values, but some devices showed substantial deviations. General practices should pay more attention to the calibration of their spirometer.
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Affiliation(s)
- Tjard R J Schermer
- COPD and Asthma Research and Development Unit, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Barnes TA, Fromer L. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting. Clin Interv Aging 2011; 6:47-52. [PMID: 21472091 PMCID: PMC3066252 DOI: 10.2147/cia.s15164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry. METHODS This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD. RESULTS A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers. CONCLUSION Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice.
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Affiliation(s)
- Thomas A Barnes
- Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA 02115-5000, USA.
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Lyngsø AM, Backer V, Gottlieb V, Nybo B, Østergaard MS, Frølich A. Early detection of COPD in primary care--the Copenhagen COPD Screening Project. BMC Public Health 2010; 10:524. [PMID: 20809934 PMCID: PMC2940916 DOI: 10.1186/1471-2458-10-524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 09/01/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world, and further increases in the prevalence and mortality are predicted. Delay in diagnosing COPD appears frequently even though current consensus guidelines emphasize the importance of early detection of the disease. The aim of the present study is to evaluate the effectiveness of a screening programme in general practice. METHODS/DESIGN Subjects aged 65 years and older registered with a General Practitioner (GP) in the eastern Copenhagen will receive a written invitation and a simple questionnaire focusing on risk factors and symptoms of COPD. Subjects who meet the following criteria will be encouraged to undergo spirometric testing at their GP: current smokers, former smokers, and subjects with no smoking history but who have dyspnea and/or chronic cough with sputum. DISCUSSION The Copenhagen COPD Screening Project evaluates the effectiveness of a two-stage screening program for COPD in general practice and provides important information on how to organize early detection of COPD in general practice in the future.
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Affiliation(s)
- Anne Marie Lyngsø
- Department of Integrated Healthcare, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Gottlieb
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Birgitte Nybo
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Marianne S Østergaard
- Department of Health Services Research, Institute of General Medicine, Copenhagen University, Denmark
| | - Anne Frølich
- Department of Integrated Healthcare, Bisbebjerg University Hospital, Copenhagen, Denmark
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Schirnhofer L, Lamprecht B, Firlei N, Kaiser B, Buist AS, Halbert RJ, Allison MJ, Studnicka M. Using Targeted Spirometry to Reduce Non-Diagnosed Chronic Obstructive Pulmonary Disease. Respiration 2010; 81:476-82. [DOI: 10.1159/000320251] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/09/2010] [Indexed: 11/19/2022] Open
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