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

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 (FEV1/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 FEV1 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.