Identifying airway obstruction in primary care: is there a role for physiotherapists?

Lisa Pagano; Sarah Dennis; Sally Wootton; Sriram Mahadev; Andrew S L Chan; Nicholas Zwar; Deborah Pallavicini; Zoe McKeough

doi:10.1186/s12875-022-01944-z

Identifying airway obstruction in primary care: is there a role for physiotherapists?

BMC Prim Care. 2022 Dec 14;23(1):324. doi: 10.1186/s12875-022-01944-z.

Authors

Lisa Pagano¹, Sarah Dennis^{1

2

3}, Sally Wootton^{1

4}, Sriram Mahadev^{4

5

6}, Andrew S L Chan^{4

5

6}, Nicholas Zwar⁷, Deborah Pallavicini⁸, Zoe McKeough⁹

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, Camperdown, NSW, 2006, Australia.
² Ingham Institute for Applied Medical Research, Sydney, Australia.
³ South Western Sydney Local Health District, Liverpool, Australia.
⁴ Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia.
⁵ Royal North Shore Hospital, St Leonards, Australia.
⁶ Northern Clinical School, University of Sydney, Sydney, Australia.
⁷ Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
⁸ Sydney North Primary Health Network, St Leonards, Australia.
⁹ Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, D18 - Susan Wakil Health Building, The University of Sydney, Camperdown, NSW, 2006, Australia. zoe.mckeough@sydney.edu.au.

Abstract

Aims: To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.

Methods: Four general practices were recruited. 'At risk' participants (aged ≥ 40 years, current/ex-smoker) and people with 'existing' COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV₁/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.

Results: One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 'at risk', 31'existing' COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of 'at risk' and 77% (24/31) of 'existing' COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV₁ were classified as A (68%), B (19%) and C (5%).

Conclusion: Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding 'at risk' patients and identifying potential misdiagnosis of obstruction in some 'existing' COPD cases.

Trial registration: ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx.

Keywords: Allied health; COPD; Diagnosis; Primary care; Spirometry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Airway Obstruction* / diagnosis
Bronchodilator Agents / therapeutic use
Female
Forced Expiratory Volume
Humans
Male
Physical Therapists*
Primary Health Care
Pulmonary Disease, Chronic Obstructive* / diagnosis

Substances

Bronchodilator Agents

Grants and funding

NSHN/16/34510/Chronic and Complex Care, Primary and Community Health, Northern Sydney Local Health District