A comparison of two models of spirometry in general practice in the identification and prevention of COPD.

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To increase recognition of airflow obstruction in primary care, two models of spirometry delivery in a target group at risk of chronic obstructive pulmonary disease (COPD) were compared in a qualitative/quantitative cluster randomised study in eight practices over 6 months; opportunistic spirometry by ‘‘visiting trained nurses’’ (TN) and optimised ‘‘usual care’’ (UC). In the eligible target population of smokers and ex-smokers aged over 35 years, 531/904 (59%) patients underwent spirometry in the TN model and 87/ 1130 (8%) patients in the UC model (p,0.0001). ATS spirometry standards for acceptability and reproducibility were met by 76% and 44% of tests in the TN and UC models, respectively (p,0.0001). GPs valued high quality spirometry and increased testing of patients at risk of COPD in the TN model. They identified limitations, including the need for better systematic follow-up of abnormal spirometry and support with interpretation, which may explain persisting underdiagnosis of COPD in practice records. Conclusions: Although opportunistic testing by visiting trained nurses substantially increased and improved spirometry performance compared with usual care, translating increased detection of airflow obstruction into diagnosis of COPD requires further support.

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