Validity and interpretation of spirometric recordings to diagnose COPD in UK primary care


Rothnie, KJ; Chandan, JS; Goss, HG; Mullerova, H; Quint, JK; (2017) Validity and interpretation of spirometric recordings to diagnose COPD in UK primary care. International journal of chronic obstructive pulmonary disease, 12. pp. 1663-1668. ISSN 1176-9106 DOI: https://doi.org/10.2147/copd.s133891

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Abstract

Background: The diagnosis of COPD is dependent upon clinical judgment and confirmation of the presence of airflow obstruction using spirometry. Spirometry is now routinely available; however, spirometry incorrectly performed or interpreted can lead to misdiagnosis. We aimed to determine whether spirometry undertaken in primary care for patients suspected to have COPD was of sufficient quality and whether their spirometry was correctly interpreted. Methods: Two chest physicians re-read all spirometric readings for both quality of the procedure and interpretation, received as a part of COPD validation studies using data from the Clinical Practice Research Datalink (CPRD). We then used logistic regression to investigate predictors of correct interpretation. Results: Spirometry traces were obtained for 306 patients, of which 221 (72.2%) were conducted in primary care. Of those conducted in primary care, 98.6% (n= 218) of spirometry traces were of adequate quality. Of those traces that were of adequate quality and conducted in primary care, and in whom a general practitioner (GP) diagnosis of COPD had been made, 72.5% (n= 218) were consistent with obstruction. Historical records for asthma diagnosis significantly decreased odds of correct interpretation. Conclusion: The quality of the spirometry procedure undertaken in primary care is high. However, this was not reflected in the quality of interpretation, suggesting an unmet training in primary care. The quality of the spirometry procedure as demonstrated by spirometric tracings provides a re-assurance for the use of spirometric values available in the electronic health care record databases for research purposes.

Item Type: Article
Keywords: pulmonary disease, chronic obstructive, general practice, respiratory, function tests, data accuracy, electronic health records, general-practice, Respiratory System
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 28652719
Web of Science ID: 402968000002
URI: http://researchonline.lshtm.ac.uk/id/eprint/3983427

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