Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD)

Wai Cho Yu,¹ Sau Nga Fu,² Emily Lai-bun Tai,³ Yiu Cheong Yeung,¹ Kwok Chu Kwong,¹ Yui Chang,¹ Cheuk Ming Tam,³ Yuk Kwan Yiu<sup>2

1</sup>Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong; ²Department of Family Medicine and Primary Healthcare, Kowloon West Cluster, Hospital Authority, Hong Kong; ³Tuberculosis and Chest Service, Department of Health, Government of Hong Kong, Special Administrative Region, Hong Kong

Abstract: Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV₁) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV₁ was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV₁, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed.

Keywords: guidelines, pulmonary function tests, specialist