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        "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 &#40;COPD&#41; in primary care in terms of deficiencies and the requirements for its correct use&#44; and to identify the regimens most commonly used in patients with COPD&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">The study included 839 primary care physicians&#44; each of whom completed 2 questionnaires&#44; one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease&#46;</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 &#40;10&#46;7&#37; of cases&#41; and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD &#40;15&#46;1&#37;&#41;&#46; The highest rate of correct responses was for questions regarding the indication for spirometry&#44; all of which were answered correctly in more than 60&#37; of cases&#46; Only 59&#46;2&#37; of primary health care centers performed spirometry&#44; mainly due to a lack of training&#46; In more than 30&#37; of cases the nursing staff had not received specific training&#44; a finding that was reflected in the poor compliance with guidelines for calibration &#40;10&#46;9&#37; of health care centers performed daily calibrations&#41;&#44; cleaning of the spirometer &#40;in 13&#46;9&#37; of cases the equipment was never cleaned&#41;&#44; and providing patients with pretest recommendations &#40;30&#37; did not provide recommendations the day before spirometry&#41;&#46;</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&#46; Although they are able to recognize airflow obstruction&#44; they do not classify patients correctly in terms of severity&#46; Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique&#44; a finding reflected in the poor compliance with guidelines for its use&#46;</p>"
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        "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 utilizaci&#243;n de la espirometr&#237;a en el diagn&#243;stico y seguimiento del paciente con enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; en atenci&#243;n primaria &#40;AP&#41; y conocer las pautas habituales de tratamiento de esta enfermedad&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Participaron 839 m&#233;dicos de AP y cada uno de ellos cumpliment&#243; 2 cuestionarios&#44; uno sobre el tratamiento de la EPOC y otro de utilizaci&#243;n de la espirometr&#237;a en su diagn&#243;stico y seguimiento&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Destac&#243; el bajo &#237;ndice tanto de respuestas a la pregunta sobre la clasificaci&#243;n de los pacientes en funci&#243;n de la gravedad de la obstrucci&#243;n &#40;no respondi&#243; el 10&#44;7&#37;&#41; como de respuestas correctas en las preguntas sobre el tratamiento broncodilatador en fase estable &#40;respuestas correctas&#58; 15&#44;1&#37;&#41;&#46; Las mayores tasas de respuestas correctas se obtuvieron en las preguntas referentes a la indicaci&#243;n de la espirometr&#237;a&#44; to-das ellas con un &#237;ndice de acierto superior al 60&#37;&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">S&#243;lo un 59&#44;2&#37; de los centros de AP realizaban espirome-tr&#237;as&#44; sobre todo debido a la falta de formaci&#243;n&#46; En m&#225;s de un 30&#37; de los casos el personal de enfermer&#237;a no hab&#237;a recibido formaci&#243;n espec&#237;fica&#44; lo que se reflejaba en un escaso seguimiento de las normativas en cuanto a calibraci&#243;n &#40;un 10&#44;9&#37; de los centros la realizaba diariamente&#41;&#44; limpieza de los apa-ratos &#40;un 13&#44;9&#37; no la hac&#237;a nunca&#41; y recomendaciones al paciente &#40;un 30&#37; no daba recomendaciones el d&#237;a antes&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los m&#233;dicos de AP conocen la utilidad de la espirometr&#237;a en el diagn&#243;stico y seguimiento de la EPOC&#46; Identifican la presencia de una obstrucci&#243;n al flujo a&#233;reo&#44; pero no se clasifica correctamente a los pacientes en funci&#243;n de su gravedad&#46; Se ha observado una escasa disponibilidad de la espirometr&#237;a en los centros de AP&#44; as&#237; como una escasa formaci&#243;n en su manejo&#44; lo que se refleja en un escaso seguimiento de las normativas de realizaci&#243;n de la prueba&#46;</p>"
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Vol. 42. Issue 12.
Pages 638-644 (December 2006)
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Vol. 42. Issue 12.
Pages 638-644 (December 2006)
Original Articles
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Use of Spirometry in the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease in Primary Care
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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
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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Article information
Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Key words:
Chronic obstructive pulmonary disease
Diagnosis
Treatment
Primary health care
Spirometry
Objetivo

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.

Métodos

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.

Resultados

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%.

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).

Conclusiones

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.

Palabras clave:
EPOC
Diagnóstico
Tratamiento
Atención primaria
Espirometría
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This study was funded by Boehringer Ingleheim, Spain, and Pfizer, Spain.

Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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