The Spiro-GP Study

The role of spirometry in the management of chronic respiratory diseases in general practice

The SPIRO-GP study aims to trial spirometry as an intervention for management of asthma and chronic obstructive pulmonary disease (COPD) in a General Practice setting.

Most guidelines for asthma and chronic obstructive pulmonary disease (COPD) stress the importance of spirometry for diagnosis and evaluation of care.

A recent review of COPD recommended that the measurement of FEV1 after the administration of a bronchodilator be performed repeatedly over the course of the disease in order to define the rate of decline in lung function, helping to focus both treatment decisions and discussions regarding prognosis. This implies that spirometry needs to be introduced on a routine basis to identify patients with a rapid FEV1 decline and to improve quality of care.

Long-term studies to evaluate the benefit of regular spirometry in the management of COPD and asthma in general practice have not yet been conducted.

Victoria has the lowest rate of Medicare claims of any state for spirometry and complex lung function tests, particularly office based tests, despite having similar prevalences of asthma and COPD to other states of Australia.

Therefore there is a unique opportunity in Victoria to investigate the role of spirometry in improving the management of chronic respiratory diseases.

The study is being conducted by a group of investigators led by Professor Michael Abramson.
The Study Coordinator is Rosa Schattner. For further information contact Rosa.Schattner@med.monash.edu.au

We plan to recruit general practices, and randomly allocate them into three groups.

• Group 1 (Intervention) practices will receive the full spirometry intervention and an interpretation of results will be notified to the treating GP
• Group 2 practices will receive spirometry before and after the trial, but results will not be reported to the GP until after the trial
• Group 3 (Control) practices will provide usual medical care only, which may include peak flow monitoring, but would not normally include spirometry

We plan to recruit 11 general practices per group, each one recruiting 22 patients with asthma or COPD aged 7 - 70 years, giving a total of 242 patients per group.

Eligible patients will attend a general practice on the list of the Divisions of General Practice in Melbourne and surrounding regions, be aged 7-70 years, have doctor diagnosed asthma or COPD, are able to understand English and provide written consent to participate.

Focus groups will also be conducted with patients and health professionals to investigate barriers and enablers of spirometry in general practice and primary care.

The primary health outcomes, to be measured at baseline, at 3, 6, 9 and 12 months, are:

• Quality of life utilising the SF36 questionnaire
• Asthma control utilising the validated Juniper questionnaire

The secondary health outcomes, to be measured at baseline and 12 months, are:

• Frequency of symptoms, written management plans and medications
• Emergency presentations to GP or Emergency Department, Hospital admissions
• Change in FEV1 (Groups 1 & 2 only)