Original Articles
Use of Spirometry in the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease in Primary Care
Karlos Naberana, Cristian de la Rozab, Maite Lambanc, Elena Gobarttd, Antonio Martíne, Marc Miravitllesb,
Corresponding author
marcm@clinic.ub.es
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España
Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España
a Grupo de Neumología de la Sociedad Catalana de Medicina de Familia, Spain
b Servicio de Neumología, Institut Clínic del Tòrax (IDIBAPS), Hospital Clínic, Barcelona, Spain
c Centro de Salud Rebolería, Zaragoza, Spain
d Departamento Médico, Boehringer Ingelheim España, Barcelona, Spain
e Departamento Médico, Pfizer España, Madrid, Spain
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"referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Maite" "apellidos" => "Lamban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "Elena" "apellidos" => "Gobartt" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] 4 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] ] ] 5 => array:4 [ "nombre" => "Marc" "apellidos" => "Miravitlles" "email" => array:1 [ 0 => "marcm@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Grupo de Neumología de la Sociedad Catalana de Medicina de Familia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Institut Clínic del Tòrax (IDIBAPS), Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Centro de Salud Rebolería, Zaragoza, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento Médico, Boehringer Ingelheim España, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Departamento Médico, Pfizer España, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. M. Miravitlles. Servicio de Neumología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-11-23" "fechaAceptado" => "2006-03-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154231" "palabras" => array:5 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Diagnosis" 2 => "Treatment" 3 => "Primary health care" 4 => "Spirometry" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154230" "palabras" => array:5 [ 0 => "EPOC" 1 => "Diagnóstico" 2 => "Tratamiento" 3 => "Atención primaria" 4 => "Espirometría" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">The study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Notable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Primary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio ha sido evaluar las defi-ciencias y necesidades para la correcta utilización de la espirometría en el diagnóstico y seguimiento del paciente con enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria (AP) y conocer las pautas habituales de tratamiento de esta enfermedad.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Participaron 839 médicos de AP y cada uno de ellos cumplimentó 2 cuestionarios, uno sobre el tratamiento de la EPOC y otro de utilización de la espirometría en su diagnóstico y seguimiento.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Destacó el bajo índice tanto de respuestas a la pregunta sobre la clasificación de los pacientes en función de la gravedad de la obstrucción (no respondió el 10,7%) como de respuestas correctas en las preguntas sobre el tratamiento broncodilatador en fase estable (respuestas correctas: 15,1%). Las mayores tasas de respuestas correctas se obtuvieron en las preguntas referentes a la indicación de la espirometría, to-das ellas con un índice de acierto superior al 60%.</p><p class="elsevierStyleSimplePara elsevierViewall">Sólo un 59,2% de los centros de AP realizaban espirome-trías, sobre todo debido a la falta de formación. En más de un 30% de los casos el personal de enfermería no había recibido formación específica, lo que se reflejaba en un escaso seguimiento de las normativas en cuanto a calibración (un 10,9% de los centros la realizaba diariamente), limpieza de los apa-ratos (un 13,9% no la hacía nunca) y recomendaciones al paciente (un 30% no daba recomendaciones el día antes).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los médicos de AP conocen la utilidad de la espirometría en el diagnóstico y seguimiento de la EPOC. Identifican la presencia de una obstrucción al flujo aéreo, pero no se clasifica correctamente a los pacientes en función de su gravedad. Se ha observado una escasa disponibilidad de la espirometría en los centros de AP, así como una escasa formación en su manejo, lo que se refleja en un escaso seguimiento de las normativas de realización de la prueba.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was funded by Boehringer Ingleheim, Spain, and Pfizer, Spain.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The global burden of disease 1990-2020" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "AD López" 1 => "CC Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/3218" "Revista" => array:6 [ "tituloSerie" => "Nat Med" "fecha" => "1998" "volumen" => "4" "paginaInicial" => "1241" "paginaFinal" => "1243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9809543" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio demográfico del tabaquismo en el Área de Salud 5 de Valencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R Peris Cardéis" 1 => "I Rico Salvador" 2 => "P Herrera de Pablo" 3 => "A Pérez Jiménez" 4 => "F Sánchez-Toril López" 5 => "JA Pérez Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "160" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15030730" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease: are women more susceptible than men?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 3 | 11 |
| 2024 October | 27 | 21 | 48 |
| 2024 September | 27 | 16 | 43 |
| 2024 August | 70 | 39 | 109 |
| 2024 July | 31 | 23 | 54 |
| 2024 June | 44 | 20 | 64 |
| 2024 May | 48 | 31 | 79 |
| 2024 April | 31 | 29 | 60 |
| 2024 March | 30 | 15 | 45 |
| 2024 February | 27 | 22 | 49 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 27 | 19 | 46 |
| 2023 January | 23 | 24 | 47 |
| 2022 December | 28 | 29 | 57 |
| 2022 November | 27 | 20 | 47 |
| 2022 October | 22 | 35 | 57 |
| 2022 September | 20 | 26 | 46 |
| 2022 August | 24 | 31 | 55 |
| 2022 July | 22 | 48 | 70 |
| 2022 June | 29 | 34 | 63 |
| 2022 May | 26 | 44 | 70 |
| 2022 April | 25 | 30 | 55 |
| 2022 March | 31 | 47 | 78 |
| 2022 February | 18 | 26 | 44 |
| 2022 January | 18 | 33 | 51 |
| 2021 December | 17 | 53 | 70 |
| 2021 November | 11 | 46 | 57 |
| 2021 October | 20 | 45 | 65 |
| 2021 September | 17 | 58 | 75 |
| 2021 August | 14 | 22 | 36 |
| 2021 July | 16 | 43 | 59 |
| 2021 June | 22 | 29 | 51 |
| 2021 May | 19 | 32 | 51 |
| 2021 April | 40 | 82 | 122 |
| 2021 March | 34 | 31 | 65 |
| 2021 February | 14 | 17 | 31 |
| 2021 January | 5 | 18 | 23 |
| 2020 December | 6 | 13 | 19 |
| 2020 November | 15 | 8 | 23 |
| 2020 October | 9 | 12 | 21 |
| 2020 September | 3 | 5 | 8 |
| 2020 August | 11 | 7 | 18 |
| 2020 July | 10 | 18 | 28 |
| 2020 June | 8 | 4 | 12 |
| 2020 May | 10 | 10 | 20 |
| 2020 April | 14 | 20 | 34 |
| 2020 March | 14 | 8 | 22 |
| 2020 February | 9 | 11 | 20 |
| 2020 January | 13 | 21 | 34 |
| 2019 December | 10 | 5 | 15 |
| 2019 November | 9 | 5 | 14 |
| 2019 October | 12 | 5 | 17 |
| 2019 September | 2 | 9 | 11 |
| 2019 August | 8 | 5 | 13 |
| 2019 July | 7 | 14 | 21 |
| 2019 June | 8 | 7 | 15 |
| 2019 May | 6 | 9 | 15 |
| 2019 April | 18 | 13 | 31 |
| 2019 March | 8 | 13 | 21 |
| 2019 February | 3 | 9 | 12 |
| 2019 January | 10 | 7 | 17 |
| 2018 December | 5 | 11 | 16 |
| 2018 November | 16 | 6 | 22 |
| 2018 October | 17 | 14 | 31 |
| 2018 September | 10 | 6 | 16 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 13 | 6 | 19 |
| 2018 March | 5 | 4 | 9 |
| 2018 February | 5 | 8 | 13 |
| 2018 January | 4 | 4 | 8 |
| 2017 December | 4 | 3 | 7 |
| 2017 November | 3 | 6 | 9 |
| 2017 October | 6 | 5 | 11 |
| 2017 September | 3 | 4 | 7 |
| 2017 August | 6 | 8 | 14 |
| 2017 July | 2 | 2 | 4 |
| 2017 June | 6 | 12 | 18 |
| 2017 May | 6 | 10 | 16 |
| 2017 April | 1 | 4 | 5 |
| 2017 March | 1 | 0 | 1 |
| 2017 February | 1 | 2 | 3 |
| 2017 January | 3 | 0 | 3 |
| 2016 December | 2 | 3 | 5 |
| 2016 November | 7 | 5 | 12 |
| 2016 October | 8 | 7 | 15 |
| 2016 September | 7 | 8 | 15 |
| 2016 August | 6 | 2 | 8 |
| 2016 July | 3 | 3 | 6 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 52 | 9 | 61 |
| 2015 September | 98 | 11 | 109 |
| 2015 August | 70 | 10 | 80 |
| 2015 July | 52 | 11 | 63 |
| 2015 June | 61 | 4 | 65 |
| 2015 May | 62 | 10 | 72 |
| 2015 April | 48 | 11 | 59 |
| 2015 March | 37 | 9 | 46 |
| 2015 February | 39 | 6 | 45 |
| 2015 January | 40 | 5 | 45 |
| 2014 December | 31 | 4 | 35 |
| 2014 November | 43 | 10 | 53 |
| 2014 October | 73 | 10 | 83 |
| 2014 September | 51 | 13 | 64 |
| 2014 August | 56 | 18 | 74 |
| 2014 July | 51 | 7 | 58 |
| 2014 June | 64 | 11 | 75 |
| 2014 May | 60 | 15 | 75 |
| 2014 April | 48 | 10 | 58 |
| 2014 March | 59 | 15 | 74 |
| 2014 February | 64 | 10 | 74 |
| 2014 January | 54 | 8 | 62 |
| 2013 December | 57 | 10 | 67 |
| 2013 November | 34 | 7 | 41 |
| 2013 October | 39 | 11 | 50 |
| 2013 September | 24 | 11 | 35 |
| 2013 August | 45 | 12 | 57 |
| 2013 July | 47 | 10 | 57 |
| 2013 June | 33 | 13 | 46 |
| 2013 May | 38 | 7 | 45 |
| 2013 April | 22 | 6 | 28 |
| 2013 March | 14 | 5 | 19 |
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