Effect of primary care spirometry on the diagnosis and management of COPD

AIM: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommends spirometry to diagnose Chronic Obstructive Pulmonary Disease (COPD). In primary care spirometry is difficult to obtain prior to commencing treatment. In Ireland it is estimated that five hundred thousand people are living with COPD yet only two hundred thousand are diagnosed. The aim of this study is to evaluate whether having access to spirometry and accurate interpretation via a Respiratory Integrated Care (RIC) Service improved diagnostic yield.METHOD: Data was collected retrospectively on patients referred with a diagnosis of or on treatment for COPD to the RIC service in the area of Dublin north city and county during the period of its commencement in June 2017-December 2019 inclusive.RESULTS: One hundred and thirty two of those referred had a diagnosis of COPD, one hundred and fifteen (87%) having had spirometry. One hundred and nine (83%) were confirmed as having the correct diagnosis. One hundred and sixty one referred had query COPD. One hundred and nineteen (74%) of those had COPD confirmed.CONCLUSION: Despite having poor access to spirometry in primary care diagnosis based on clinical assessment in primary care was more accurate than envisaged. However one hundred and fifty nine (54%) referrals required a change in their treatment as per the GOLD guideline. No referrals whether previously diagnosed or not had been given action plans or been referred to Pulmonary Rehabilitation. By supporting General Practitioners and enhancing spirometry capacity at primary care level RIC provides assistance with accurate diagnosis and ensures COPD patients receive GOLD standard care. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest References and Clinical Trial Registry Information