Airway Obstruction In Primary Care Patients: Need For Implementing Spirometry Use

Spirometry is the objective measurement to detect airway obstruction. In some patients respiratory symptoms related to airway obstruction are not present, when airway obstruction is detected by spirometry. Aim of the present study was to detect early airway obstruction in an adult population sample in a primary care setting. METHODS Seventeen general practitioners were involved and 912 patients were asked to participate in the study, between January and June 2014: of them, 583 (323M), aged 40-92 yrs, accepted and were investigated through a respiratory questionnaire, the mMRC dyspnoea scale, and spirometry through the Quark PFT (Cosmed, Italy) spirometer. Smoking habits, BMI, respiratory symptoms, doctor respiratory diagnoses, dyspnoea score, and forced expirograms were obtained. Based on answers on doctor diagnosis, we identified 4 subgroups: doctor COPD diagnosis (COPD); doctor Asthma diagnosis (A); Asthma COPD Overlap Syndrome (ACOS); no respiratory diagnosis (NRD). For screening purposes, a FEV1/FVC<70% was considered a marker of airway obstruction. Severity was determined by FEV1 level: I mild (FEV1>=80% of predicted); II moderate (50-79%), III severe (30-49%); IV more severe (<30%). RESULTS One hundred and ninety subjects were current smokers, 235 ex smokers and 155 non smokers. Prevalence rates of cough, sputum, wheezing and dyspnoea were 27%, 26%, 32%, 44%, respectively. Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% (95) showed airway obstruction: of them, 26% mild, 56% moderate, 17% severe, 1% very severe. Among obstructed subjects 12% did not report any respiratory symptom and were distributed among FEV1 levels I-III. Those reporting neither respiratory symptoms nor respiratory doctor diagnosis were 60% in level I; 43% in level II; 44% in level III; none in level IV. In obstructed vs not obstructed individuals, a higher frequency of smokers (?2=.002) and a higher mMRC score (?2<.05) were found. A significant association among cough, sputum, wheezing, dyspnoea and obstruction was found (?2<.001). In a logistic model, wheezing (p=.001), sputum (p=.036), smoking habits (p=.028), and older age (p=.0001) were the best predictors of airway obstruction. CONCLUSIONS We found an elevated prevalence of airway obstruction in our sample of primary care adults associated with elevated respiratory symptoms prevalence and smoking. However, a high prevalence of subjects without symptoms or medical diagnoses was found among obstructed patients, indicating the need of implementing spirometry in family practice as early diagnosis tool