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    PC RJ 200295

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    Mihai Petrescu
    1) The study examined the accuracy of spirometry tests performed in general practices compared to a pulmonary function laboratory. 2) Spirometry tests were first performed on 299 COPD patients in a laboratory and then repeated in their general practices within a few days using the same equipment. 3) The spirometry values for FEV1 and FVC obtained in the general practices were on average higher than the values in the laboratory tests, though the differences were small.

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    PC RJ 200295

    Uploaded by

    Mihai Petrescu
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    1) The study examined the accuracy of spirometry tests performed in general practices compared to a pulmonary function laboratory. 2) Spirometry tests were first performed on 299 COPD patients in a laboratory and then repeated in their general practices within a few days using the same equipment. 3) The spirometry values for FEV1 and FVC obtained in the general practices were on average higher than the values in the laboratory tests, though the differences were small.

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    Pc Rj 200295

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    1) The study examined the accuracy of spirometry tests performed in general practices compared to a pulmonary function laboratory. 2) Spirometry tests were first performed on 299 COPD patients in a laboratory and then repeated in their general practices within a few days using the same equipment. 3) The spirometry values for FEV1 and FVC obtained in the general practices were on average higher than the values in the laboratory tests, though the differences were small.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views1 page

    PC RJ 200295

    Uploaded by

    Mihai Petrescu
    1) The study examined the accuracy of spirometry tests performed in general practices compared to a pulmonary function laboratory. 2) Spirometry tests were first performed on 299 COPD patients in a laboratory and then repeated in their general practices within a few days using the same equipment. 3) The spirometry values for FEV1 and FVC obtained in the general practices were on average higher than the values in the laboratory tests, though the differences were small.

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    Not to be reproduced without the permission of the Primary Care Respiratory Journal
    subgroups of severity of airway obstruction based on their post-bronchodilator FEV1 percentage predicted value (FEV1 % predicted; 80%:
    no obstruction; 70-80%: mild obstruction; 50-70%: moderate obstruction; <50%: severe obstruction). Exacerbation-related health care costs
    were determined by counting the units of resources consumed and converting these into monetary values (€).
    Results: Mean age of the 286 patients involved was 59.2 (SD 9.6) years, post-bronchodilator FEV1 % predicted was 67.1 (SD 16.2). Of all
    patients, 220 (77%) experienced at least one exacerbation during the 2-year observation period. Mean annual exacerbation rate was 0.88 (SD
    0.79). The annual exacerbation rate did not differ between the subgroups of severity of airway obstruction (p=0.628). Mean health care cost
    per exacerbation was €67 (95% CI 57, 77). When costs were expressed as the annual exacerbation cost per patient, the mean costs in the
    severity subgroups were €80, €106, €122 and €183, respectively (p=0.013). The gradual increase of the annual exacerbation cost across
    severity subgroups was mainly attributable to more physician consultations and more prescriptions for bronchodilators and other reliever
    medication.
    Conclusions: The occurrence rate of exacerbations in COPD may not depend on the severity of airway obstruction, but the annual
    exacerbation-related health care cost per patient appear to increase as obstruction becomes more severe.

    Discontinuation of inhaled steroid treatment in chronic obstructive pulmonary disease. An observational study in general practice
    (Prim Care Respir J 2002; 11(3) 96)
    Tjard Schermer1, Annie Hendriks2, Niels Chavannes2, Richard Dekhuijzen3, Miel Wouters4, Henk van den Hoogen1, Onno van
    Schayck2, Chris van Weel1
    1Department of General Practice/Family Medicine, University Medical Centre, St Radboud, Nijmegen, The Netherlands. 2Department of
    General Practice/Family Medicine, University of Maastricht, Maastricht The Netherlands. 3Department of Pulmonology, University Medical
    Centre St Radboud, Nijmegen, The Netherlands.4Department of Pulmonology, University Hospital Maastricht, Maastricht, The Netherlands

    Objectives: To assess the probability and explore determinants of an adverse respiratory outcome after discontinuation of inhaled
    corticosteroid treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed in general practice. Design - Prospective
    observational inhaled steroid withdrawal study.
    Setting: 45 Dutch general practices. Participants - 232 subjects with a general practice based diagnosis of COPD with various degrees of
    airflow limitation. All subjects were treated with inhaled steroids.
    Main outcome measures: Probability of, and time to an adverse respiratory event within 3 to 7 months after inhaled steroid withdrawal.
    Results: Overall probability of an adverse respiratory event was 0.37 (95% CI 0.31, 0.44). Mean number of days until adverse respiratory
    event was lowest when steroid withdrawal was initiated in January through April and July through August (p=0.072). Univariately, those
    experiencing an adverse respiratory event tended to be more often female, were older and showed higher reversibility of airflow limitation.
    Multivariate survival analysis resulted in a hazard ratio for females of 2.14 (95% CI 1.31, 3.50) compared to males. For age, the hazard ratio
    was 1.05 (95% CI 1.02, 1.08) per year of increased age. Depending on the baseline inhaled steroid dosage, age, gender, smoking status and
    reversibility were independent predictors of adverse respiratory event after discontinuation of inhaled steroid treatment.
    Conclusions: Abrupt withdrawal of inhaled steroids is likely to harm at least some patients with COPD. Probability of an adverse respiratory
    response after inhaled steroid withdrawal may vary throughout the year and appears to be higher in women, elderly subjects, smokers and
    subjects with reversible airflow limitation.

    Accuracy of spirometry in general practice. results of an evaluation study in patients with chronic obstructive pulmonary disease
    (COPD) (Prim Care Respir J 2002; 11(3) 96)
    Tjard Schermer1, Niels Chavannes2, Annelies Jacobs2, Hans Folgering3, Ben Bottema1,2
    1Department of General Practice / Family Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.2Centre for Quality
    of Care Research, University Medical Centre/ University of Maastricht, Maastricht The Netherlands. 3University Lung Centre Dekkerswald,
    Groesbeek, The Netherlands

    Background: - At this time, many general practices in the Netherlands have their own spirometer. However, there are indications in the
    literature that spirometry performed in the general practice setting may be inaccurate.
    Aims: To compare FEV1 and FVC values obtained in general practice to a 'gold standard', i.e. the same parameters obtained in a pulmonary
    function laboratory by an experienced lung function technician.
    Methods: General practitioners and practice assistants from 61 Dutch general practices were trained to perform spirometry. Subsequently,
    these practices recruited patients with COPD for study participation. For each patient, pre- and post-bronchodilator (BD) FEV1 and FVC
    values were first assessed in a pulmonary function laboratory and within a few days again in the patients' own general practice. The same
    type of spirometer (Microloop II, MicroMedical Ltd.) and spirometry software (Spirare, Diagnostica Ltd.) was used in all practices as well as
    in the pulmonary function laboratory.
    Results: Pairs of spirometric tests were available for 299 patients. (197 males, mean age 59.2 [SD 9.6], mean FEV1 % predicted 62.8 [SD
    17.6]). Pre-BD FEV1 was on average 79 ml (95% CI 55, 103) and FVC 99 ml (95% CI 54, 143) higher for the general practice
    measurements. For post-BD measurements, FEV1 was 61 ml (95% CI 39, 84) and FVC 49 ml (95% CI 3, 95) higher, also in favour of the
    general practice measurements.
    Conclusion: Relevant spirometric values (FEV1, FVC) obtained in general practice appear to be equivalent to values obtained in a
    pulmonary function laboratory. Further analyses of our data are required to eliminate possible alternative explanations for this rather
    unexpected finding.

    96 Primary Care Respiratory Journal

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