1
|
Chapron A, Lemée T, Pau G, Jouneau S, Kerbrat S, Balusson F, Oger E. Spirometry practice by French general practitioners between 2010 and 2018 in adults aged 40 to 75 years. NPJ Prim Care Respir Med 2023; 33:33. [PMID: 37777534 PMCID: PMC10542800 DOI: 10.1038/s41533-023-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023] Open
Abstract
In France, most spirometries are performed by pneumologists. Spirometry is difficult to access due to the distance to medical office and long delays for appointments. This lack of accessibility contributes to the underdiagnosis of chronic obstructive pulmonary disease (COPD) among patients aged between 40 and 75 years. In recent years, general practitioners (GPs) have been performing spirometry in private practice. However, the extent of this practice is unknown. A French retrospective, repetitive transversal study analysed data from the "Système National des Données de Santé" (SNDS) database. The targeted population was GPs in primary care that performed spirometries between 2010 and 2018, in patients aged between 40 and 75 years. Between 2010 and 2018, 302,674 (7.2%) spirometries were performed in France by GPs in private practices, in patients 40 to 75 years old. 5.4% by "expert GPs" (>60 spirometries/year) and 1.8% by "non-expert GPs". In "non-expert GPs" (2.8% of French GPs in 2018), the annual number of spirometries increased by 701 each year (p < 2.104), the annual number of GPs performing spirometries increased by 114 each year (p < 2.10-5). Overall, 24.9% of the spirometries performed by GPs were referrals from other GPs. The number of spirometries performed by GPs and the number of GPs performing spirometries has gradually increased over time. However, this increase is inadequate considering the need to early detect and follow up respiratory disorders.
Collapse
Affiliation(s)
- A Chapron
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Department of General Practice, Rennes, France.
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-1414, Rennes, France.
- Rennes University, CHU Rennes, INSERM, Ecole des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail (IRSET) - UMR_S 1085, Rennes, France.
| | - T Lemée
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Department of General Practice, Rennes, France
| | - G Pau
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Department of General Practice, Rennes, France
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-1414, Rennes, France
| | - S Jouneau
- Rennes University, CHU Rennes, INSERM, Ecole des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail (IRSET) - UMR_S 1085, Rennes, France
- CHU Rennes, Department of Respiratory Medicine, Rennes, France
| | - S Kerbrat
- Rennes University, CHU Rennes, INSERM, Ecole des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail (IRSET) - UMR_S 1085, Rennes, France
| | - F Balusson
- Rennes University, CHU Rennes, INSERM, Ecole des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail (IRSET) - UMR_S 1085, Rennes, France
| | - E Oger
- Rennes University, CHU Rennes, INSERM, Ecole des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail (IRSET) - UMR_S 1085, Rennes, France
| |
Collapse
|
2
|
Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Costa N, Conte C. Healthcare resource consumption prior to asthma-related death: a nationwide descriptive study. Ther Adv Respir Dis 2022; 16:17534666221130217. [PMID: 36239261 PMCID: PMC9577087 DOI: 10.1177/17534666221130217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although asthma mortality declined sharply until the mid-2000s, a stagnation in mortality has been observed over the past decade in different countries. OBJECTIVE The objective of this study is to describe healthcare resource consumption for patients who died from asthma in France. METHOD This study was conducted using data from the French National Health Data System. Patients who died from asthma between 2013 and 2017 were identified by the ICD10 codes J45 and J46. Health care consumption data were collected. Patients were categorized into four categories according to age: ⩾75, (18-75), (12-18), (0-12). Daily doses of ICS were categorized according to GINA guidelines. RESULTS A total of 3829 patients were included. No ICS or an inadequate ICS dose was observed in 43.8%, 50.6%, 48.1%, and 54.0% of patients aged ⩾75, (18-74), (12-18), and (0-12) years, respectively. Dispensation of six or more SABA canisters was observed in 37.2%, 49.0%, and 70.3% of patients aged of ⩾75, (18-75), and (12-18) years, respectively. Omalizumab dispensation rate was very low [1.1% and 2.8% in patients aged ⩾75 and (18-75) years)]. The proportion of patients with a pulmonologist office visit was 13.8% and 14.6% in patients ⩾75 and (18-75) years, respectively. A lung function test was noted in only 18.6%, 28.3%, and 25.9% of patients ⩾75, (18-75) and (12-18) years, respectively. CONCLUSION Half of the patients who died from asthma received inadequate ICS doses and only a small proportion had access to biological therapies. Less than 15% were referred to a specialist.
Collapse
Affiliation(s)
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Agnès Sommet
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des Voies Respiratoires, Service de
Pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse,
France,Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France,CRISALIS F-CRIN, Toulouse, France
| | - Laurent L. Reber
- Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Cécile Conte
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| |
Collapse
|
3
|
Accuracy of portable spirometers in the diagnosis of chronic obstructive pulmonary disease A meta-analysis. NPJ Prim Care Respir Med 2022; 32:15. [PMID: 35440665 PMCID: PMC9019105 DOI: 10.1038/s41533-022-00275-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Portable spirometers has been approved for diagnosing chronic obstructive pulmonary disease (COPD). However, their diagnostic accuracy has not been reviewed. Therefore, the purpose of this study was to systematically evaluate the diagnostic value of portable spirometers in detecting COPD. A comprehensive literature search for relevant studies was conducted in PubMed, Embase, CNKI, Wan Fang, and Web of Science databases. Pooled sensitivity, specificity, summary receiver operating characteristic (SROC), area under the curve (AUC), and other related indices were calculated using the bivariate mixed-effect model. Subgroup analysis was performed to explore the source of heterogeneity. Thirty one studies were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), SROC, and AUC of the SROC of portable spirometers were 0.85 (0.81–0.88), 0.85 (0.81–0.88), 5.6 (4.4–7.3), 0.18 (0.15–0.22), 31 (21–46) and 0.91 (0.89–0.94), respectively. Among the three commonly used types of portable spirometers, the accuracy of PIKO-6 was higher (0.95) than that of COPD-6 (0.91) and PEF (0.82). Subgroup analysis indicated that the accuracy of a multi-indices portable spirometer was higher than that of a single-index one (P < 0.05). In addition, portable spirometry performed by professional technicians in tertiary hospitals was more accurate than for those conducted by trained technicians in primary care facilities and communities (P < 0.05). Moreover, the accuracy of studies conducted in developing country was superior to developed country (P < 0.05). Portable spirometers have high accuracy in the diagnosis of COPD. Multi-index COPD-6 and PIKO-6 displayed higher accuracy than others. Standardized training of instrument operators should be considered to achieve reliable results.
Collapse
|
4
|
Chaiwong W, Namwongprom S, Liwsrisakun C, Pothirat C. Diagnostic Ability of Impulse Oscillometry in Diagnosis of Chronic Obstructive Pulmonary Disease. COPD 2020; 17:635-646. [PMID: 33121279 DOI: 10.1080/15412555.2020.1839042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The diagnosis of chronic obstructive pulmonary disease (COPD) mainly relies on spirometry. Due to the complexity of spirometry, easier-to-do impulse oscillometry (IOS) has been introduced as a complementary approach to conventional pulmonary function testing. Therefore, this study aimed to assess the efficacy of the diagnostic ability of IOS for diagnosing chronic obstructive pulmonary disease (COPD). This cross-sectional study was conducted at the Lung Health Center, Chiang Mai University, Thailand, between June 2019 and January 2020. IOS and spirometry were performed with all subjects suspected of having COPD. A Receiver Operating Characteristic (ROC) curve was plotted, the area under the ROC (AuROC) and 95%CI were compared among COPD and chronic smokers. One hundred and seventeen subjects suspected of having COPD with a mean age of 68.6 ± 8.6 years old were enrolled. Of these 103 (88.0%) were male. Thirty healthy subjects were also enrolled. IOS parameters including resistance at 5 Hz (R5), resonant frequency (Fres), area under reactance (AX), heterogeneity of resistance (R5-R20), and reactance at 5 Hz (X5) demonstrated excellent overall accuracy relative to the diagnosis of COPD with an AuROC ranging from 0.80 - 0.84. The AX ≥ 8.66 cmH2O/L represented an AuROC = 0.79, with a sensitivity of 79.1% and a specificity of 78.0% for the diagnosis of COPD. IOS is a valuable tool for use in the diagnosis of COPD. It may be used in subjects who cannot carry out the spirometric procedure.
Collapse
Affiliation(s)
- Warawut Chaiwong
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirianong Namwongprom
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
5
|
Lorenzo M, Delpeyroux S, Dupre V. [Pack-years threshold and HAS self-questionnaire for COPD early diagnosis]. Rev Mal Respir 2020; 37:624-632. [PMID: 32675005 DOI: 10.1016/j.rmr.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Haute Autorité de santé (HAS) in France offers a patient self-questionnaire to optimize targeted chronic obstructive pulmonary disease (COPD) screening among at-risk patients in primary care. It includes smoking but does not have a threshold for pack-years (PY) smoked. The objective of this study was to compare the positive predictive values (PPV) of the HAS self-questionnaire alone and with the addition of a PY threshold. METHODS This was a prospective pilot study conducted in a multi-professional health centre. Identification among smoking or former smoking patients without a COPD diagnosis of subjects with a positive HAS self-questionnaire, a positive PY threshold, or both. We performed spirometry after bronchodilatation. RESULTS Thirty-five people were included in the study. All 35 had a positive PY threshold. The HAS questionnaire was positive for 22 of them (62.9%). Spirometry diagnosed 18 participants with COPD (51%). The PPV for the HAS questionnaire was 0.41 and the PPV for the HAS+PY questionnaire was 0.51. There was no statistically significant difference between these two PPVs (P=0.3692). CONCLUSIONS The addition of a PY threshold to the HAS self-questionnaire may allow better targeting of the population at risk of developing COPD.
Collapse
Affiliation(s)
- M Lorenzo
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France; Maison de santé pluriprofessionnelle Guillaume Tell, 2, place Guillaume-Tell, 68100 Mulhouse, France.
| | - S Delpeyroux
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France
| | - V Dupre
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France; Maison de santé pluriprofessionnelle Guillaume Tell, 2, place Guillaume-Tell, 68100 Mulhouse, France
| |
Collapse
|
6
|
Pennequin N, Léger P, Freymond N, Coullandaye N, Poupon D, Tranchard É, Cuoq O, Pacheco Y. [Feasibility and benefits of training to screen for chronic obstructive pulmonary disease]. Rev Mal Respir 2019; 36:861-869. [PMID: 31279593 DOI: 10.1016/j.rmr.2019.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/09/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Though still under-diagnosed, chronic obstructive pulmonary disease (COPD) currently affects nearly 3.5 million people in France. The present study presents the results of continuing medical education sessions on COPD screening by electronic mini-spirometry. METHODS From April 2013 to December 2015, the sessions involved 73 health professionals. The study analysed three questionnaires administered before, after, and long after sessions led by experts within a professional associative network. RESULTS The sessions proved efficient in increasing the participants' theoretical knowledge. It increased the percentage of correct answers regarding the nature of COPD (90 % vs. 81%), the functions, features, and outputs of mini-spirometers, and the treatment recommendations. The sessions led to non-negligible changes in everyday medical practice regarding the acquisition of a mini-spirometer (+13 devices), the presentation of COPD to the patients (+33 practitioners), the dialogue on tobacco use (+32 practitioners), vaccination (+33 practitioners), and compliance with the treatment recommendations (+43 practitioners). CONCLUSION These results encourage both holding and following up such sessions. The specialized professional environment ensures knowledge updates and offers subsequent assistance. Further improving these sessions will increase their benefits in terms of diagnosis, treatment, and health economy.
Collapse
Affiliation(s)
- N Pennequin
- Cabinet de médecine générale, 69100 Villeurbanne, France
| | - P Léger
- Réseau de santé SPIRO, 69003 Lyon, France
| | - N Freymond
- Service de pneumologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | | | - D Poupon
- Réseau de santé SPIRO, 69003 Lyon, France
| | - É Tranchard
- Laboratoire d'exploration fonctionnelle respiratoire, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - O Cuoq
- Cabinet de médecine générale, 69100 Villeurbanne, France
| | - Y Pacheco
- Service de pneumologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France.
| |
Collapse
|
7
|
Bunge L, Baruch D, Plantier L, Mazars T, Roche N, Izadifar A. [Study of the feasibility of spirometry in general practice]. Rev Mal Respir 2018; 35:238-248. [PMID: 29605653 DOI: 10.1016/j.rmr.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/05/2017] [Indexed: 10/17/2022]
Abstract
COPD is common but is under-diagnosed by general practitioners (GP). GP have a major role in the early diagnosis of this disease. GP could have access to spirometry. The aim of this study was to evaluate the quality and interpretation of spirometry performed by primary care residents following a short education session. Three residents were trained in spirometry for half a day. They then performed spirometry on all smokers over the age of 35 visiting five general practices. The results were reviewed blindly by an independent specialist pulmonologist to assess their quality and interpretation. Among 184 eligible patients, 89% agreed to participate and 66% (n=107) came for the second appointment. The pulmonologist evaluated the quality of spirometry as good in 72% of cases, of suboptimal but acceptable quality in 20% and of poor quality in 8%. Interpretation was accurate in 91% of tests. The Kappa concordance coefficient between GPs and the expert was 0.93. Airflow obstruction was detected in 17.5% of the screened subjects. The average time for a consultation with spirometry was 19minutes. The consultation dedicated to spirometry was well accepted by patients. A short training has to be structured to allow GPs to perform and interpret spirometry properly. This work needs to be extended to better assess reproducibility in cases of abnormal spirometry.
Collapse
Affiliation(s)
- L Bunge
- Clinique universitaire de médecine générale, université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - D Baruch
- Médecine générale, université Paris-Diderot, 75013 Paris, France
| | - L Plantier
- Service des explorations fonctionnelles, hôpital Bichat (75), 75018 Paris, France
| | - T Mazars
- Médecine générale, université Paris-Diderot, 75013 Paris, France
| | - N Roche
- Service de pneumologie, hôpital Cochin (75), 75014 Paris, France
| | - A Izadifar
- Centre cardiologique du Nord, 93200 Saint-Denis, France
| | | |
Collapse
|