Spirometry trial questions treatment guidelines

28 July 2010

A Melbourne-based trial of patients with asthma and chronic obstructive pulmonary disease (COPD) has found that regular monitoring of lung function does not necessarily lead to an improvement in a patient's condition, ability to manage the condition or their quality of life.

The year-long trial of spirometry (the measuring of lung capacity, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled) followed more than 250 patients who were regularly engaged in spirometry testing compared with usual care.

Thirty-one General Practices agreed to participate in the trial. The practice GPs then identified and recruited trial participants for the duration of the study.

Lead researcher, Professor Michael Abramson, Deputy Head Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, said the study results did not agree with existing guidelines for asthma and COPD, which encourage regular monitoring with spirometry to help with condition management.

"It is important to stress that spirometry is a critical tool in the diagnosis of COPD and asthma, but this study has questioned the effectiveness of its ability to help manage patients who already have the condition," Professor Abramson said.

"We found that the recommended regular three-monthly spirometry and medical review made little difference to quality of life, respiratory symptoms, asthma attacks, written asthma action plans or health care service use in adult patients with asthma or COPD."

Professor Abramson said this latest research into the role spirometry plays in condition management was a valuable addition to medical care.

"Few long-term studies had evaluated the benefit of regular spirometry in the management of COPD and asthma in general practice. Victoria has the lowest rate of Medicare claims of any Australian state for spirometry and complex lung function tests, despite having a similar prevalence of asthma and COPD to other states this presented a unique opportunity to investigate the role of spirometry in improving the management of chronic respiratory diseases," Professor Abramson said.

"We would have considerable difficulty recommending more widespread use of spirometry in Australian general practices to guide the management of such patients. However, there is still likely to be a role for spirometry as a 'gold standard' to establish the diagnosis when patients first present."

Professor Abramson and colleagues at Monash University are finalising other data from the research, that shows the importance of spirometry in diagnosis of patients with COPD and asthma.

"My recommendation to patients with COPD and asthma is to continue their regular visits to their doctor, not necessarily to undergo spirometry testing every time, but to ensure their medication can be reviewed, and to maintain general health."

The team also included Monash University researchers Rosa Schattner, Kate Birch, Pam Simpson, Dr Rosalie Aroni, Associate Professor Rory Wolfe and Associate Professor Frank Thien, Dr Nabil Sulaiman from the University of Melbourne and Nory Del Colle from Pulmetrics.

The trial was funded by the National Health and Medical Research Council (NHMRC) and involved researchers from the University of Melbourne and Pulmetrics. The findings of the study are published in last week's edition of the Medical Journal of Australia.