title: A centralised respiratory diagnostic service for primary care: a  4-year audit.
abstract: BACKGROUND
  The literature shows that delayed or erroneous diagnosis of respiratory conditions may be common in primary care due to underuse of spirometry or poor spirometric technique. The Community Respiratory Assessment Unit (CRAU) was established to optimise diagnosis and treatment of respiratory disease by providing focused history-taking, quality-assured spirometry, and evidence-based guideline-derived management advice.
  
  
  OBJECTIVE
  To review the service provided by the CRAU to primary care health professionals.
  
  
  METHODS
  Data from 1,156 consecutive GP referrals over 4 years were analysed.
  
  
  RESULTS
  From the 1,156 referrals, 666 were referred for one of five common reasons: suspected asthma, confirmed asthma, suspected chronic obstructive pulmonary disease (COPD), confirmed COPD, or unexplained breathlessness. COPD was the most prevalent referral indication (445/666, 66.8%), but one-third of suggested diagnoses of COPD by the GP were found to be incorrect (161/445, 36%) with inappropriate prescribing of inhaled therapies resulting from this misdiagnosis. Restrictive pulmonary defects (56/666, 8% of referrals) were overlooked and often mistaken for obstructive conditions. The potential for obesity to cause breathlessness may not be fully appreciated.
  
  
  CONCLUSIONS
  Misdiagnosis has significant financial, ethical, and safety implications. This risk may be minimised by better support for primary care physicians such as diagnostic centres (CRAU) or alternative peripatetic practice-based services operating to quality-controlled standards.
authors.affiliation: Imperial College London, NHLI Division at Charing Cross Hospital, London, UK.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Starren
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Roberts
authors.forename: Mehreen
authors.initials: M
authors.lastname: Tahir
authors.forename: Louise
authors.initials: L
authors.lastname: O'Byrne
authors.forename: Rachel
authors.initials: R
authors.lastname: Haffenden
authors.forename: Irem S
authors.initials: IS
authors.lastname: Patel
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D015272:Pulmonary Medicine / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy
chemical_list: D001993:Bronchodilator Agents