title: Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD.
abstract: BACKGROUND
  Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care.
  
  
  OBJECTIVE
  To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry.
  
  
  METHODS
  A before-and-after quasiexperimental design.
  
  
  METHODS
  Three hundred eighty-two patients from 12 family medicine practices across the United States.
  
  
  METHODS
  Patients with asthma and COPD, and staff from the 12 practices.
  
  
  METHODS
  Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing.
  
  
  RESULTS
  Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD.
  
  
  CONCLUSIONS
  US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.
authors.affiliation: Olmsted Medical Center, Department of Research, 210 Ninth St SE, Rochester, MN 55904, USA. yawnx002@umn.edu
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.forename: Paul L
authors.initials: PL
authors.lastname: Enright
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: Wilson
authors.initials: W
authors.lastname: Pace
authors.forename: Peter
authors.initials: P
authors.lastname: Wollan
authors.forename: Homer
authors.initials: H
authors.lastname: Boushey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis*; D002648:Child; D019468:Disease Management; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D013147:Spirometry