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BMC Pulmonary Medicine

, 9:31

First Online: 10 July 2009Received: 04 March 2009Accepted: 10 July 2009

Abstract

BackgroundTo evaluate the sensitivity, specificity and predictive values of spirometry for the diagnosis of chronic obstructive pulmonary disease COPD and asthma in patients suspected of suffering from an obstructive airway disease OAD in primary care.

MethodsCross sectional diagnostic study of 219 adult patients attending 10 general practices for the first time with complaints suspicious for OAD. All patients underwent spirometry and structured medical histories were documented. All patients received whole-body plethysmography WBP in a lung function laboratory. The reference standard was the Tiffeneau ratio FEV1-VC received by the spirometric maneuver during examination with WBP. In the event of inconclusive results, bronchial provocation was performed to determine bronchial hyper-responsiveness BHR. Asthma was defined as a PC20 fall after inhaling methacholine concentration ≤ 16 mg-ml.

Results90 41.1% patients suffered from asthma, 50 22.8% suffered from COPD, 79 36.1% had no OAD. The sensitivity for diagnosing airway obstruction in COPD was 92% 95%CI 80–97; specificity was 84% 95%CI 77–89. The positive predictive value PPV was 63% 95%CI 51–73; negative predictive value NPV was 97% 95%CI 93–99. The sensitivity for diagnosing airway obstruction in asthma was 29% 95%CI 21–39; specificity was 90% 95%CI 81–95. PPV was 77% 95%CI 60–88; NPV was 53% 95%CI 45–61.

ConclusionCOPD can be estimated with high diagnostic accuracy using spirometry. It is also possible to rule in asthma with spirometry. However, asthma can not be ruled out only using spirometry. This diagnostic uncertainty leads to an overestimation of asthma presence. Patients with inconclusive spirometric results should be referred for nitric oxide NO – measurement and-or bronchial provocation if possible to guarantee accurate diagnosis.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2466-9-31 contains supplementary material, which is available to authorized users.

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Autor: Antonius Schneider - Lena Gindner - Lisa Tilemann - Tjard Schermer - Geert-Jan Dinant - Franz Joachim Meyer - Joachim Szec

Fuente: https://link.springer.com/



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