Spirometery and Its Application in Medical Practice for Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) Patients in Karachi, Pakistan
American Journal of Internal Medicine
Volume 3, Issue 3, May 2015, Pages: 146-152
Received: May 24, 2015; Accepted: May 29, 2015; Published: Jun. 11, 2015
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Muhammad Noman Rashid, Department of Physiology, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
Izhar Fatima, Department of Pathology, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
Farha Ahmed, Department of Community Health Sciences, Ziauddin University, Karachi, Pakistan
Ali Muhammad Soomro, Department of Physiology, University of Sindh, Jamshoro, Sindh, Pakistan
Beenish Noman, Department of Obstetrics &Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
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Introduction: Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in districts of, Karachi. Material and Methods: It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Results: Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. Conclusion: We conclude that spirometry is underused in general but especially by non-respiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed.
Guidelines, Pulmonary Function Tests, FEV1, FVC
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Muhammad Noman Rashid, Izhar Fatima, Farha Ahmed, Ali Muhammad Soomro, Beenish Noman, Spirometery and Its Application in Medical Practice for Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) Patients in Karachi, Pakistan, American Journal of Internal Medicine. Vol. 3, No. 3, 2015, pp. 146-152. doi: 10.11648/j.ajim.20150303.19
Global Initiative for Chronic Obstructive Lung Disease, Inc. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease – 2013 update. Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf. Accessed April 8, 2013.
World Health Organization [homepage on the Internet]. Burden of COPD. Geneva: World Health Organization. Available from: http://www.who.int/respiratory/copd/burden/en. Accessed June 27, 2013.
Mannino DM, Buist AS. Global burden of COPD: risk factors, preva¬lence, and future trends. Lancet. 2007;370:765–773.
Chan-Yeung M, Lai CK, Chan KS, et al. The burden of lung disease in Hong Kong: a report from the Hong Kong Thoracic Society. Respirology. 2008;13 Suppl4:S133–S165.
Ko FW, Woo J, Tam W, et al. Prevalence and risk factors of airflow obstruction in an elderly Chinese population. Eur Respir J. 2008;32(6): 1472–1478.
Lau AC, Ip MS, Lai CK, et al. Variability of the prevalence of undiagnosed airflow obstruction in smokers using different diagnostic criteria. Chest. 2008;133(1):42–48.
Hardie JA, Buist AS, Vollmer WM, et al. Risk of overdiagnosis of COPD in asymptomatic elderly nonsmokers. Eur Respir J. 2002;20(5): 1117–1122.
Cerveri I, Coriscico AG, Accoridini S, et al. Underestimation of airflow obstruction among young adults using FEV1/FVC , 70% as a fixed cutoff: a longitudinal evaluation of clinical and functional outcomes. Thorax. 2008;63(12):1040–1045.
Johannessen A, Lehmann S, Omenaas ER, et al. Post bronchodilator spirometry reference values in adults and implications for disease management. Am J Respir Crit Care Med. 2006;173(12):1316–1325.
Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179–191.
National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care – 2010 update. Available from: http://guidance.nice.org.uk/CG101. Accessed April 8, 2013.
Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1986;133(1):14–20.
Burrows B. The course and prognosis of different types of chronic airflow limitation in a general population sample from Arizona: compari¬son with the Chicago “COPD” series. Am Rev Respir Dis. 1989;140(3 Pt 2):S92–S94.
Yu WC, Tai LB, Fu SN, et al. Treatment of patients with chronic obstructive pulmonary disease as practiced in a defined Hong Kong community: a cross-sectional pilot survey. Hong Kong Med J. 2011;17(4):306–314.
Miller MR, Hankinson J, Brusasco V, et al; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J. 2005; 26(2): 319–338.
Ip MS, Ko FW, Lau AC, et al. Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization. Chest. 2006;129(2):384–392.
Guyatt GH, Pugsley SO, Sullivan MJ, Thompson PJ, Berman L, Jones NJ. Effect of encouragement on walking test performance. Thorax. 1984;39:818–822.
BestellJC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–586.
Arne M, Lisspers K, Stallberg B, et al. How often is diagnosis of COPD confirmed with spirometry? Respir Med. 2010;104(4):550–556.
Bourbeau J, Sebaldt RJ, Day A, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary care practice: the CAGE study. Can Respir J. 2008;15(1):13–19.
Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large population-based survey. Am J Respir Crit Care Med. 2007;176(8):753–760.
JooMJ, Lee TA, Weiss KB. Geographic variation of spirometry use in newly diagnosed COPD. Chest. 2008;134:38–45.
Lee TA, Bartle B, Weiss KB. Spirometry use in clinical practice following diagnosis of COPD. Chest. 2006;129:1509–1515.
Eaton T, Withy S, Garrett JE, et al. Spirometry in primary care practice: the importance of quality assurance and the impact of spirometry workshops. Chest. 1999;116:416–423.
PoelsPJ, SchermerTR, Jacobs A, et al. Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer. Scand J Prim Health Care. 2006;24:81–87.
Bolton CE, Ionescu AA, Edwards PH, et al. Attaining a correct diagnosis of COPD in general practice. Respir Med. 2005;99:493–500.
PoelsPJ, Schermer TR, Schellekens DP, et al. Impact of a spirometry expert system on general practitioners’ decision making. EurRespir J. 2008;31:84–92.
Damarla M, Celli BR, Mullerova HX, Pinto-Plata VM. Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure. Respir Care. 2006;51(10):1120–1124.
Kaminsky DA, March TW, Bachand M, Irvin CG. Knowledge and use of office spirometry for the detection of chronic obstructive pul¬monary disease by primary care physicians. Respir Care. 2005;50(12): 1639–1648.
Yawn BP, Enright PL, Lemanske RFJr, et al. Spirometry can be done in family physicians’ offices and alters clinical decisions in management of asthma and COPD. Chest. 2007;132(10):1162–1168.
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