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A centralised respiratory diagnostic service for primary care: a 4-year audit

Starren, Elizabeth S.; Roberts, Nicola J.; Tahir, Mehreen; O'Byrne, Louise; Haffenden, Rachel; Patel, Irem S.; Partridge, Martyn R.


Elizabeth S. Starren

Mehreen Tahir

Louise O'Byrne

Rachel Haffenden

Irem S. Patel

Martyn R. Partridge


The literature shows that delayed or erroneous diagnosis of respiratory conditions may be common in primary care due to underuse of spirometry or poor spirometric technique. The Community Respiratory Assessment Unit (CRAU) was established to optimise diagnosis and treatment of respiratory disease by providing focused history-taking, quality-assured spirometry, and evidence-based guideline-derived management advice.

To review the service provided by the CRAU to primary care health professionals. Methods: Data from 1,156 consecutive GP referrals over 4 years were analysed.

From the 1,156 referrals, 666 were referred for one of five common reasons: suspected asthma, confirmed asthma, suspected chronic obstructive pulmonary disease (COPD), confirmed COPD, or unexplained breathlessness. COPD was the most prevalent referral indication (445/666, 66.8%), but one-third of suggested diagnoses of COPD by the GP were found to be incorrect (161/445, 36%) with inappropriate prescribing of inhaled therapies resulting from this misdiagnosis. Restrictive pulmonary defects (56/666, 8% of referrals) were overlooked and often mistaken for obstructive conditions. The potential for obesity to cause breathlessness may not be fully appreciated.

Misdiagnosis has significant financial, ethical, and safety implications. This risk may be minimised by better support for primary care physicians such as diagnostic centres (CRAU) or alternative peripatetic practice-based services operating to quality-controlled standards.


Starren, E. S., Roberts, N. J., Tahir, M., O'Byrne, L., Haffenden, R., Patel, I. S., & Partridge, M. R. (2012). A centralised respiratory diagnostic service for primary care: a 4-year audit. Primary Care Respiratory Journal, 21(2), 180-186.

Journal Article Type Article
Acceptance Date Jan 2, 2012
Online Publication Date Mar 19, 2012
Publication Date 2012-06
Deposit Date Aug 30, 2022
Journal Primary Care Respiratory Journal
Print ISSN 1471-4418
Electronic ISSN 1475-1534
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 21
Issue 2
Pages 180-186
Public URL