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Chronic Obstructive Pulmonary Disease (COPD) is underestimated, underdiagnosed and often undertreated in the general population. A survey of 17 structured questions, delivered to all Belgian pulmonary physicians (PPs) (116 responses), evaluated diagnosis and treatment strategies in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2010 and assessed opinions about the importance of diurnal variation of COPD symptoms. All COPD diagnoses (37% new cases) were spirometry confirmed. Main diagnostic parameters were symptoms (99%), external risk factors (99%), clinical examination (97%), exacerbations (96%) and patient mobility (96%). FEV 1 (forced expiratory volume in 1s) (97%) or FEV1/FVC (ratio of FEV1 to forced vital capacity) (93%) were used most to assess diagnosis and severity. The 3 most important therapeutic objectives were symptom relief, preventing exacerbations, and improving quality of life; if these were not reached, the preferred strategy (60% of PPs) was adding another medication. Treatment strategies varied with COPD stage: short-acting β2-agonists (90%) and shortacting anti-cholinergics (59%) were used for GOLD I disease, whereas for higher stages long-acting β2-agonists (36-48%) and long-acting anti-cholinergics (79%) were given with inhaled corticosteroids (21-67%). Symptoms were perceived to vary throughout the day, affecting quality of life (97%) and mobility (89%). In particular, respiratory symptoms were more severe in the morning (51- 92%), leading PPs to adapt treatment (69%). This survey demonstrated that management of COPD by PPs in Belgium is generally in line with the GOLD guidelines 2010 and that they perceive morning symptoms as being frequent and having an impact on patient's life., SCOPUS: ar.j, info:eu-repo/semantics/published

Office spirometry added significantly more to the diagnostic certainty of the GPs than questionnaires, history and clinical examination. A pulmonologist's advice contributed more to diagnostic certainty than any other diagnostic step. Nevertheless, 26% of the diagnoses made by the chest physicians were reconsidered by the GPs.

Dit onderzoek bevestigt dat spirometrie in de huisartsgeneeskunde bij patiënten met het vermoeden van luchtwegobstructie te weinig als diagnostisch hulpmiddel wordt gebruikt. Bijna de helft van de patiënten ouder dan veertig jaar die bronchodilatatoren en/of corticosteroïden inhaleerden, hadden een verdere uitwerking van hun diagnose nodig.

To document the rate of diagnostic certainty, co-morbidity and use of medication in patients with presumed obstructive airway disease (OAD) in a primary care setting.

To assess the success rate of smoking cessation with the "minimal intervention strategy" in general practice, and to determine the influence of spirometry on this success rate.

Study objectives: To investigate the technical properties and user friendliness of 10 office spirometers devoted for use in general practice, and to compare the results with standard diagnostic spirometers. Design: Multicenter study. Setting: Ten spirometer models were tested independently in three pulmonary function laboratories and by three general practitioners (GPs). Measurements: The laboratories studied the technical quality of the office spirometers in terms of precision and agreement with standard spirometers, whereas the three GPs assessed their user friendliness. The spirometers tested were as follows: Spirobank (Medical International Research; Rome, Italy); Simplicity (Puritan Bennett; Pleasanton, CA); OneFlow (Clement Clarke International; Harlow, Essex, UK); Datospir 70 (Sibelmed; Barcelona, Spain); Datospir 120 (Sibelmed); SpiroPro (SensorMedics; Yorba Linda, CA); EasyOne (NDD; Zurich, Switzerland); MicroLoop (Micro Medical; Chatham, Kent, UK); SpiroStar (Medikro; Kuopio, Finland); and Pneumotrae (Vitalograph; Maids Moreton, Buckingham, UK). FVC and FEV1 were measured in 399 subjects. User friendliness was assessed by the three GPs using a questionnaire. Results: The precision of FEV1 of the office and standard spirometers was comparable, but three office spirometers had > 200 mL limits of precision for FVC. Some devices presented a proportional difference on the FEV, with standard spirometers, underestimating the small values. The limits of agreements between standard and some office spirometers for FEV1/FVC ratio was > 10%. The overall user friendliness was estimated as good. Conclusions: The global quality and user friendliness of several office spirometers make them acceptable for the detection of COPD, although differences between the laboratory and some of the office spirometers values suggest that the misclassification rates may be increased when using some models of office spirometers.

Recently performed long term trials have enhanced the insight into the assessment of progression of COPD. The present review focuses on the initial assessment of COPD in general practice and the assessment of disease progression. Several variables may be used to assess this progression, all of which are associated with significant methodological problems. Finding the appropriate mix of outcome measures to capture all aspects of disease progression is a significant challenge., Journal Article, Research Support, Non-U.S. Gov't, Review, info:eu-repo/semantics/published

To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire.

SCOPUS: ar.j, info:eu-repo/semantics/published