title: Do spirometry and regular follow-up improve health outcomes in general practice patients with asthma or COPD? A cluster randomised controlled trial.
abstract: OBJECTIVE
  To determine whether spirometry with regular medical review improves the quality of life or other health outcomes among patients with asthma or chronic obstructive pulmonary disease (COPD) managed in general practice.
  
  
  METHODS
  Cluster randomised controlled trial conducted in 31 general practices in Melbourne during 2007-2008. Practices recruited 305 adult patients who had been prescribed inhaled medication in the preceding 6 months.
  
  
  METHODS
  Practices were randomly assigned to one of three groups: Group A patients received 3-monthly spirometry performed by a respiratory scientist with results returned to the practice and regular medical review; Group B patients received spirometry only before and after the trial; and Group C patients received usual care.
  
  
  METHODS
  Quality of life, assessed with the 36-item Short Form (SF-36) Australian (English) Version 2 questionnaire at baseline and 3, 6, 9 and 12 months. Secondary outcomes were assessed with the European Community Respiratory Health Survey at baseline and 12 months.
  
  
  RESULTS
  The trial was completed by 253 participants: 79 in Group A, 104 in Group B, and 70 in Group C. Median age was 58 years (range, 18-70 years), and 167 participants (66%) were women. There were no significant changes in SF-36 Physical and Mental Component Summary scores from baseline to 12 months, or significant differences between groups on either scale or any subscale of the SF-36. There were also no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation.
  
  
  CONCLUSIONS
  Three-monthly spirometry and regular medical reviews by general practitioners are not associated with any significant improvement in quality of life or other health outcomes for patients with asthma and/or COPD.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12606000378527.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. michael.abramson@monash.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Abramson
authors.forename: Rosa L
authors.initials: RL
authors.lastname: Schattner
authors.forename: Nabil D
authors.initials: ND
authors.lastname: Sulaiman
authors.forename: Kate E
authors.initials: KE
authors.lastname: Birch
authors.forename: Pam P
authors.initials: PP
authors.lastname: Simpson
authors.forename: Eleonora A
authors.initials: EA
authors.lastname: Del Colle
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Aroni
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Francis C K
authors.initials: FC
authors.lastname: Thien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011787:Quality of Health Care; D011788:Quality of Life; D013147:Spirometry / Q000706:statistics & numerical data; D014739:Victoria