Use of spirometry among chest physicians and primary care physicians in India

Abstract

Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value <0.01), 18% among GenPs (P value=0.01), 20% among GPs (P value: not significant) and 224% among Ps (P value <0.01). The reasons for not using spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.

Figure 1

Changes in the use of spirometry by chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps) between the years 2005 and 2013.

Figure 2

Mode of diagnosis of asthma by chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps) in the year 2013. In all, 75.72% of Ps, 72.69% of general practitioners, 54.16% of GenPs and 23.57% of CPs diagnosed asthma by clinical judgement; 9.38% of Ps, 12.82% of general practitioners, 17.19% of GenPs and 40.37% of CPs diagnosed asthma by spirometry/peak expiratory flow rate (PEFR); and 14.90% of Ps, 14.50% of general practitioners, 28.65% of GenPs and 36.07% of CPs diagnosed asthma by both clinical judgement and spirometry/PEFR.

Figure 3

Mode of diagnosis of COPD by chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps) in the year 2013. In all, 64.90% of general practitioners, 50.55% of GenPs and 18.93% of CPs diagnosed COPD by clinical judgement; 16.78% of general practitioners; 21.70% of GenPs and 46.91% of CPs diagnosed COPD by spirometry/PEFR; and 18.32% general practitioners, 27.75% of GenPs and 34.16% of CPs diagnosed COPD by both clinical judgement and spirometry/ PEFR.

Figure 4

The study population and break-up between the years 2005 and 2013.