The Nationwide Questionnaire Survey For Clinical Application Of Pulmonary Function Testing In China

Background:The normal function of the respiratory system is very essential for the maintenance ofhuman life. Pulmonary function tests include the assessment of pulmonary ventilation,ventilation control, lung capacity, transportation between lung and blood, respiratoryrhythm control etc. Pulmonary function test is very important for the assessment and thediagnosis of diseases and monitoring the respiratory system function etc. The applicationof pulmonary function test has a long history.1. Clinical application of pulmonary function testIt has important clinical significances of pulmonary function tests, which were oftenused to improve diagnosis of chronic respiratory diseases and the identification of manyrespiratory disease states, and clear the severity of respiratory diseases. Besides it has animportant role in monitoring acute and chronic respiratory diseases.and the objectiveevaluation of responses to therapy, and preoperatively to determining thecardio-respiratory status of surgical patients. It is also an essential prediction of diseaseprognosis and identification of labor ability. It is a widely used tool to study the relationshipbetween environment and diseases. Global strategy for the diagnosis, management, andprevention of chronic obstructive pulmonary disease (GOLD), and the global initative forglobal initative for bronchial asthma (GINA),the guidelines to COPD, asthma, andbronchiectasis in China have emphasized the importance of the tests.2. Investigation and clinical application of pulmonary function in China At present, pulmonary function tests have been increasingly diversified, and reflectanomalous pulmonary function from various angles of respiration. Then how is thepulmonary function test in the practical application in China?In2002, Zheng Jinping carried out the survey on clinical application of pulmonaryfunction test firstly, reporting some important aspects of the situation, such as the types ofthe test, the applications of different departments, the machines for the tests, the normalvalue to select and so on. It put forward that the development of pulmonary function testin China was still uneven, and we should strengthen the understanding of clinicalapplication of pulmonary function test.Ten years has gone. Whether the problems put forward in2002are improved or not?Whether clinical application is improved or not? Where does the development of the testgo? Therefore, we conduct the survey on the application of pulmonary function test inChina. Clinicians and patients are also very important for the application of the test.Selection and the frequency of application of pulmonary function test in patients and theinterpretation of the results are influenced by the cognitive of clinicians. The complianceof the test are up to the cognition in patients. Therefore, we included the clinicians and thesubjects in the survey, carrying on multi-dimensions analysis of the application ofpulmonary function test.Objective：1. To investigate the clinical application of pulmonary function test and the progressin recent10years.2. To evaluate the current knowledge and awareness of pulmonary function testamong physicians in China.3. To investigate the subjects’ knowledge and awareness of the pulmonary functiontest, promoting the pulmonary function test and helping to adjust strategies forclinical applications in China. Part I：Response from staffs of pulmonary function test LabMethods：A nationwide questionnaire survey for hospitals which conducted thepulmonary function test was carried out, and parts of the results were compared with thefindings of the survey in2002.Results：The survey was carried out in89hospitals including65.2%of tertiaryhospitals. Of the pulmonary function tests conducted in our country, spirometricmeasurement (100%) and bronchial diastolic test (86.5%) were most widely performed.The investigation shows that there was no one answering the quality control standards ofpulmonary function test completely. Disinfection of sensors accounted for77.9%(53/68).Frequency of disinfection once a week was41.2%(28/68), and disinfection byimmersing was75.4%. Bronchial asthma (82.8%,72/87) and chronic obstructivepulmonary disease (77.0%,67/87) were the major indications of pulmonary functiontests. The most frequently reported adverse event was respiratory symptoms (80.4%).24.7%of the hospitals were training points in the survey. Compared with2002, there isno significant difference in the composition of hospital levels (P>0.05), and the test ismainly in spirometric measurement.The percent of histamine provocation wassignificantly lower than that in2002(41.3%vs76%, P<0.05), but the methacholineprovocation was significantly higher (54.3%vs27.9%, P<0.05).Conclusion：Pulmonary function test is developing in our country. Quality control,disinfection and continuous medical education need more performance improvements.PartⅡ：Response from physicians from different levels of hospitalsMethods：A nationwide questionnaire survey relating to pulmonary function testwas carried out in416hospitals in three levels(tertiary, secondary, and primary)from31provinces in China. The perspectives of various professional degrees of the medical staffsfrom different levels of hospitals were further studied.Results：A total of1211questionnaires were recovered (questionnaires fromtertiary level of hospitals accounted for70.2%, the others from secondary and primarylevels of hospitals accounted for29.8%). There were more physicians knowing the test in tertiary level of hospitals than in the secondary and primary levels of hospitals. Thepercentage of physicians of respiratory department knowing the test was thehighest(100%).There were significant differences between the awareness rates ofdepartments (χ2=53.554, P<0.05). Both were most aware of the importance of pulmonaryfunction test in aiding the diagnosis of respiratory diseases (78.6%vs78.2%). Small part ofthe doctors stated that pulmonary function test was useful for monitoring the progressionof a respiratory disease, preoperative evaluation of surgical patients and so on. Respiratoryphysicians were most aware of pulmonary function test in aiding the diagnosis ofrespiratory diseases (86.7%vs68.6%vs72.8%, P<0.01). Pediatricians were most aware ofrole of pulmonary function test in determining the severity of respiratory diseases（54.3%vs42.5%vs38%, P<0.01）. In response to questions of determining the pulmonaryfunction tests that would be performed on patients with bronchial asthma or COPD, thepercentage of physicians in tertiary level were similar with that in secondary and primarylevels (82.3%vs78.1%, P>0.05).The percentage of physicians reporting that thespirometry was useful for interstitial lung disease and tuberculosis in tertiary level wassignificantly higher than that in secondary and primary levels（41.2%vs31.8%，P<0.01；10.6%vs6.2%，P<0.05. All physicians in different departments were lack of knowledgethat pulmonary function test was useful for bronchiectasis（14.7%vs12.0%vs13.3%,P>0.05.89%of the respondents reported that pulmonary function tests were conducted intheir hospitals. The spirometric measurement (98.4%), bronchial dilation test (88.5%)andthe measurement of lung volumes（82.4%）were the main test. Medical staffs in all levelsof the hospital thought that it was necessary to strengthen the training for pulmonaryfunction test, but the demand in tertiary hospitals was slightly higher than that in thenon-tertiary hospitals (89.1%vs84.5%, P<0.05).Conclusion: Pulmonary function test was developing in our country, but theknowledge of pulmonary function test were poor among hospital-based doctors in Chinaincluding respiratory physicians. Pulmonary function test workshops must be addressed inorder to increase the knowledge of pulmonary function test among doctors. PartⅢ：Response from subjects who were performed pulmonary function test inhospitalsMethods: We carried out a cross-sectional survey among subjects who wasperformed pulmonary function test in hospitals. Information on knowledge, awareness ofpulmonary function test were obtained using a questionnaire with17questions and thedata were then analysed.Results: A total of2,508effective questionnaires were collected from60hospitals orclinics located in16provinces or autonomous regions of mainland China. The majority ofthe respondents were over the age of40(66.96%). The most usual way of the respondentsknowing the tests was hearing from the physicians (75.02%,949/1265).27.8%ofresponders had spirometry ever done prior to study visit.62.10%of responders agreedwith that pulmonary function test was useful for diagnosis of respiratory disease.60.54%of responders agreed that pulmonary function test helped determining the severity ofrespiratory diseases.1746(69.59%) responders completed the pulmonary function test in30minutes.39.8%of responders considered next pulmonary function test.89.1%ofresponders agree to the pulmonary function test accepted as one of the routineexamination of projects.Conclusion: At present, the knowledge and awareness of subjects on pulmonaryfunction test was still poor. We should improve the communication between medical staffsand subjects and provide more advocacy and education about the application of pulmonaryfunction for clinical publicity, improving the knowledge and awareness of the public onpulmonary function test. The pulmonary function test should accept as a routine physicalexamination.