The use of Spirometry in COPD diagnosis, auditing a snap shot of the current practice in a Libyan tertiary center’s Chest unit.

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent condition in Benghazi, Libya, and is well-known to impose a significant burden on global mortality and morbidity. International guidelines firmly establish spirometry as the gold standard for diagnosing and monitoring COPD. However, in routine clinical practice, it is often observed that a diagnosis of COPD is made on clinical grounds alone, without the crucial objective confirmation provided by spirometric testing. Objective: This audit aimed to explore the practice of using spirometry to diagnose COPD, as recommended by international standards, within the Chest Unit of Benghazi Medical Center (BMC). Material and Methods: We conducted a retrospective review of all patient files available in the chest unit during March 2023. Data about patients' demographics and diagnostic workups, particularly the rationale relied upon by physicians to make the diagnosis, including imaging and pulmonary function tests they were compared to the standard practice recommended by the GOLD guidelines for COPD diagnosis. Results: From a total of 1129 outpatient files, we identified 143 patients who had been labeled as having COPD. Their ages ranged from 36 to 85 years, and the vast majority were male. Our analysis revealed that only 88 of these 143 COPD patients (61.5%) had undergone spirometer testing, while the remaining 55 patients (38.5%) had been diagnosed without this essential investigation. Smoking status was not detailed in 41 patients (28.7%), chest radiographs were absent from the files in 67.8% of cases, and CT scans of the chest were documented in only 28.7% of patients. Conclusion: We, in total, achieved 62% of the audit's standard for spirometry use, leading to the inference that spirometry remains underused in the diagnosis of COPD in this snapshot.