Diagnosis and management of chronic obstructive pulmonary disease by primary health care physicians

Abstract

OBJECTIVE: The purpose of this study was the evaluation of the role of primary health care physicians in the diagnosis and management of chronic obstructive pulmonary disease (COPD)). METHOD: Sixty-five primary care physicians answered a questionnaire. They were required to select the main and two other findings from the history, physical examination, chest X-ray and lung function tests used in the diagnosis and follow-up of patients with chronic bronchitis, emphysema and asthma. The physicians then indicated the medicines used in the treatment of COPD in the chronic phase and during exacerbations. RESULTS: Of the patients examined by general practitioners, 11.5% suffered from COPD. Only 23 of the 65 physicians considered that chronic productive cough is the main finding of chronic bronchitis. Twelve physicians diagnosed emphysema on the basis of the chest X-ray, physical examination and history of smoking. Only 6 of the 65 considered that diffusion capacity is helpful in the diagnosis of emphysema. About one in four physicians considered that spirometry is necessary in the follow-up of COPD patients. Theophylline tablets and mucolytics were the most popular medicines prescribed in COPD, and adrenergic inhalers in exacerbations of the disease. CONCLUSIONS: Because the role of primary health care physicians in the management of COPD is major, the authors conclude that more educational programmes are needed to improve their knowledge about the interpretation of clinical findings and especially, the use of lung function tests in the diagnosis and treatment of chronic bronchitis and emphysema.