Spirometry use in primary-care & uncertainty of its predicted values in India

Although the use of spirometry is poor in India, it is improving. In the absence of predicted values for spirometry for India, physicians use different equations derived from the west. Aims to study a)the burden of Asthma & COPD (OADs) seen by physicians across India.b) Mode of diagnosis of these patients.c) Which predicted equations for spirometry are used to determine asthma & COPD severity. Methods 4100 practicing physicians [1100 chest physicians (CP), 1000 general physicians (Gen Ps), 1000 general practitioners (GPs) and 1000 pediatricians (Ps)] randomly selected from different parts of the country were invited to participate in this study and completed a 1-page questionnaire that captured information on the no. of OADs seen in their clinic per week,method of determining severity, reference values used during spirometry & reasons for not using spirometry. Results: 2196 doctors responded & provided clean data (CPs 22.5%, Gen Ps 33.9%, GPs 22.1%, Ps 19.4% and others 1.2%). Each physician saw an average of 26.2±33 asthmatics and 20.4±28 COPD patients per week. Spirometers were present in 32.2% clinics of physicians and 19.6% and 27.3% used spirometry to define asthma & COPD severity respectively. Reference values for spirometry used were: Knudson-21.4%, ECCS-17.2%, NHANES-15.7%. 32.2% did not know which reference values they used. The common reasons for not using spirometry were: too busy (32.3%), patients cannot afford(28.8%), difficult to perform (10.3%).Conclusions: Clinicians need to be motivated to use spirometry routinely in clinical practice. They use different predicted values to determine OAD severity. There is urgent need to derive predicted values for spirometry for the Indian population.