Identifying airway obstruction in primary care: is there a role for physiotherapists?

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9918300889006676 Publication Model: Electronic Cited Medium: Internet ISSN: 2731-4553 (Electronic) Linking ISSN: 27314553 NLM ISO Abbreviation: BMC Prim Care Subsets: MEDLINE

Original Publication: [London] : BioMed Central Ltd., [2022]-

Physical Therapists* ; Pulmonary Disease, Chronic Obstructive*/diagnosis ; Airway Obstruction*/diagnosis; Humans ; Female ; Aged ; Male ; Forced Expiratory Volume ; Bronchodilator Agents/therapeutic use ; Primary Health Care

Aims: To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.
Methods: Four general practices were recruited. 'At risk' participants (aged ≥ 40 years, current/ex-smoker) and people with 'existing' COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV 1 /FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.
Results: One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 'at risk', 31'existing' COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of 'at risk' and 77% (24/31) of 'existing' COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV 1 were classified as A (68%), B (19%) and C (5%).
Conclusion: Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding 'at risk' patients and identifying potential misdiagnosis of obstruction in some 'existing' COPD cases.
Trial Registration: ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx.
(© 2022. The Author(s).)

Respiration. 2010;79(6):469-74. (PMID: 19786731)
NPJ Prim Care Respir Med. 2021 Feb 11;31(1):7. (PMID: 33574260)
Chest. 2006 Jun;129(6):1509-15. (PMID: 16778268)
Chest. 2022 Apr;161(4):888-905. (PMID: 34740591)
Multidiscip Respir Med. 2019 Sep 09;14:28. (PMID: 31516702)
Eur Respir J. 2005 Aug;26(2):319-38. (PMID: 16055882)
Med J Aust. 2013 Feb 18;198(3):144-8. (PMID: 23418694)
Prim Care Respir J. 2013 Sep;22(3):331-7. (PMID: 23966214)
Int J Chron Obstruct Pulmon Dis. 2015 Aug 28;10:1711-8. (PMID: 26357469)
Breathe (Sheff). 2018 Sep;14(3):243-245. (PMID: 30186525)
Fam Pract. 2017 Aug 1;34(4):485-490. (PMID: 27694575)
Respir Med. 2007 Aug;101(8):1753-60. (PMID: 17448651)
Respir Med Res. 2021 Nov;80:100853. (PMID: 34385099)
Ann Am Thorac Soc. 2016 Dec;13(12):2119-2124. (PMID: 27598295)
BMC Womens Health. 2021 Mar 23;21(1):122. (PMID: 33757512)
Med J Aust. 2011 Aug 15;195(4):168-71. (PMID: 21843115)
Fam Pract. 2016 Dec;33(6):663-670. (PMID: 27535327)
Chest. 1988 Mar;93(3):580-6. (PMID: 3342669)
Aust Fam Physician. 2005 Mar;34(3):201-3. (PMID: 15799676)
Respir Med. 2011 Oct;105(10):1507-15. (PMID: 21549584)
Respir Care. 2005 Dec;50(12):1639-48. (PMID: 16318645)
Chest. 2019 Aug;156(2):277-288. (PMID: 30711480)
Med J Aust. 2018 Jan 15;208(1):29-34. (PMID: 29320670)
Lancet Respir Med. 2016 Sep;4(9):720-730. (PMID: 27444687)
Prim Care Respir J. 2011 Dec;20(4):396-402. (PMID: 21687918)
BMJ Open Respir Res. 2020 Jul;7(1):. (PMID: 32631928)
Respir Med. 2007 Mar;101(3):525-30. (PMID: 16908127)
Cancer Epidemiol Biomarkers Prev. 2016 Jun;25(6):907-17. (PMID: 27197277)
Prim Care Respir J. 2009 Sep;18(3):130-47. (PMID: 19684995)
Am J Respir Crit Care Med. 2017 Dec 1;196(11):1463-1472. (PMID: 29192835)
Pulm Med. 2017;2017:7620397. (PMID: 28321336)
NPJ Prim Care Respir Med. 2018 May 22;28(1):17. (PMID: 29789607)
Respir Care. 2016 Sep;61(9):1192-200. (PMID: 27165420)
Respir Med. 2010 Apr;104(4):550-6. (PMID: 19931443)
Chest. 2015 Oct;148(4):971-985. (PMID: 25950276)
Pilot Feasibility Stud. 2020 Sep 23;6:138. (PMID: 32983555)
CMAJ. 2010 Apr 20;182(7):673-8. (PMID: 20371646)
Br J Gen Pract. 2019 Jan;69(678):e1-e7. (PMID: 30559109)
Eur Respir J. 2005 Jul;26(1):153-61. (PMID: 15994402)
BMC Fam Pract. 2020 Nov 18;21(1):235. (PMID: 33208085)
Prim Care Respir J. 2007 Feb;16(1):41-8. (PMID: 17297526)
Int J Gen Med. 2011;4:729-39. (PMID: 22114517)
Thorax. 2008 May;63(5):402-7. (PMID: 18234906)
Eur Respir J. 2009 Sep;34(3):648-54. (PMID: 19720809)
Intern Med. 2017 Dec 1;56(23):3153-3158. (PMID: 28943559)
Aust Fam Physician. 2009 Oct;38(10):826-30. (PMID: 19893824)
Am J Respir Crit Care Med. 2019 Oct 15;200(8):e70-e88. (PMID: 31613151)
Int J Chron Obstruct Pulmon Dis. 2017 Jun 07;12:1663-1668. (PMID: 28652719)
NPJ Prim Care Respir Med. 2015 Aug 27;25:15056. (PMID: 26313400)
NPJ Prim Care Respir Med. 2016 Sep 29;26:16059. (PMID: 27684728)
Prim Care Respir J. 2007 Apr;16(2):82-8. (PMID: 17377688)
Int J Chron Obstruct Pulmon Dis. 2017 Sep 18;12:2753-2761. (PMID: 29075108)

NSHN/16/34510 Chronic and Complex Care, Primary and Community Health, Northern Sydney Local Health District

Keywords: Allied health; COPD; Diagnosis; Primary care; Spirometry

0 (Bronchodilator Agents)

Date Created: 20221214 Date Completed: 20221216 Latest Revision: 20240909

20240909

PMC9748384

10.1186/s12875-022-01944-z

36517744