UNDERUSE OF SPIROMETRY BY FAMILY PHYSICIANS FOR THE DIAGNOSIS OF COPD IN ITALY G. Bettoncelli, G. Caramori, R. Tosatto, F. Arpinelli, G. Visonà, A. Gerace, I.M. Adcock, A. Ciaccia

BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease (GOLD) underlines that spirometry is the gold standard as the most reproducible, standardized and objective way of measuring airflow limitation in the diagnosis and assessment of chronic obstructive pulmonary disease (COPD) However, studies undertaken in different countries suggest a widespread underuse of spirometry by family physicians to establish the diagnosis of COPD (Table 1) Precise estimates of the prevalence of physician-diagnosed COPD in Italy are not available in the literature.

AIM OF THE STUDY To investigate the degree of use of spirometry by family physicians to establish the diagnosis of COPD in Italy

METHODS In collaboration with the Italian Academy of Family Physicians (SIMG) a standardized questionnaire has been self-administered to a sample of 2425 Italian family physicians (representing 5% of all the Italian doctors involved in family practice). They have been chosen to cover all the Italian counties.

RESULTS (I) The prevalence of physician-diagnosed COPD in Italy is approximately 4% (Figure 1) 30% of family physicians in Italy do not use spirometry to establish the diagnosis of COPD (Figure 2)

RESULTS (II) The main reasons given by the family physicians for the failure to use spirometry are (Figure 3): - spirometry is not necessary for the diagnosis of COPD - there are logistical limitations to the patients’ access to lung function laboratories

CONCLUSIONS Contrary to GOLD guidelines, in Italy, as with other countries, spirometry is not always used in the diagnosis of COPD by family physicians. There is a clear necessity for further education initiatives targeted to this group of doctors.

Mean national data (±s.d.): 40.5 ±30.9 patients Mean national data (±s.d.): 50.2 ±35.3 patients pazienti Mean number of COPD patients for family physician with 500–1000 people Mean number of COPD patients for family physician with people Figure 1

Spirometry use of family physicians in Italy for COPD diagnosis % Figuermedici n.d ,2% 72,8% 28,0% 72,0% 34,1% 65,9% 0% 50% 100% NorthCentreSouth Yes= 70,0% No = 30,0% Figure 2

0,6% 40,9% 63,3% 0%20%40%60%80% It is not useful Clinical assessment is enough Logistical problems % Figuermedici % medici Figure 3 Main reasons for unuse of spirometry by family physicians in Italy