Primary Care Respiratory Journal vol:18 issue:1 pages:34-40
Study Objectives: To document the rate of diagnostic certainty, co-morbidity and use of medication in patients with presumed obstructive airway disease (OAD) in a primary care setting.
Methods: Twenty-six general practioners (GPs) were asked to select the last 50 contacts with patients older than 40 years of age who were taking bronchodilators and/or inhaled corticosteroids or who had known OAD. After reviewing their medical data on file, the GPs gave their diagnostic opinion and rated their certainty about the diagnosis using a Likert-type scale.
Results: Analysis of 126 files revealed that in at least 523 patients (4,4%), a diagnostic work-up was judged necessary The GPs judged that 6% of the patients had no OAD. Less than 33% of the study population underwent spirometry during the two years preceding the survey. The number of co-morbid conditions was on average 2,2 for patients with asthma and 3,2 for patients with COPD. Patients with presumed COPD took significantly more drugs (mean 5.1: 95% CI 4.8-5.3) than did patients with other diagnostic labels (mean, 4.6 95% CI, 4.4-4.8)
Conclusions: We confirmed the underuse of spirometry as a diagnostic tool in presumed airway obstruction in primary care. Nearly half of the patients older than 40 years who were taking bronchodilators and/or inhaled corticosteroids needed a diagnostic work-up. This population had a high prevalence of co-morbidity and polypharmacy.