Office spirometry can improve the diagnosis of obstructive airway disease in primary care setting

Introduction: Spirometry may reveal pre-clinical abnormal airway function in asymptomatic subjects and allow a better definition of severity in clinically diagnosed asthma and COPD. The hypothesis of this study was that telespirometry might increase the diagnostic accuracy of asthma and COPD. Methods: In the Italian "Alliance" study, 638 general. practitioners (GPs) were trained to perform telespirometry and were asked to enrol the following categories of subjects: (a) current or ex-smokers without respiratory symptoms; (b) subjects with respiratory symptoms but without a pre-existing diagnosis of asthma or COPD; (c) subjects with a pre-existing clinical diagnosis of asthma; and (d) subjects with a pre-existing clinical. diagnosis of COPD. Subjects completed a case report form (CRF) and performed telespirometry in the GP's office. Traces were sent by telephone to a Telespirometry Central Office, where they were interpreted by a pulmonary specialist, according to appropriately defined criteria. The results were returned in real time to the GP. Results: Overall, 9312 subjects were recruited and 7262 (78%) performed an acceptable telespirometric examination and the CRF. In the asymptomatic group, 340/1437 (24%) of the telespirometries were abnormal (147 with moderate-to-severe airway obstruction, i.e. FEV1 <80% of predicted). Among symptomatic subjects, 1433/3725 (38%) had abnormal telespirometries (682 with mode rate-to-severe obstruction). Of the asthmatic subjects, 336/1285 (26%) had moderate-to-severe airway obstruction, white telespirometry was normal in 184/815 (23%) of the COPD group. Conclusion: Telespirometry, performed in a GP's office, can aid the diagnosis of obstructive airway diseases and could help GPs to better manage airway obstruction. (C) 2008 Elsevier Ltd. All rights reserved.