Table 5 Actions for the GP to perform

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1) Indicate on the clinical record the status of smoker, ex-smoker, never smoker;

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2) indicate on the clinical record occupational risk factors (e.g. welding, zinc workers, etc.);

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3) train oneself and nursing staff in the use of risk cards, questionnaires, simple spirometry, and how to perform one;

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4) use the computerized risk card;

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5) administer the questionnaire to subjects at risk;

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6) perform a simple spirometry (see below) for initial identification of disease;

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7) perform a global spirometry on subjects with altered spirometry;

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8) refer patients who present alterations to the pulmonary specialist for diagnostic confirmation, staging, and therapy prescription;

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9) monitor subjects at risk who are still without manifest disease, and try to enroll them in a smoking cessation project;

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10) refer to the pulmonary specialist subjects with negative results on spirometry but persistent diagnostic suspicion of chronic respiratory disease.

The GP should be assisted by:

  - a secretary (point 1, 2);

  - a nurse under the GP’s supervision (point 3, 4, 5, 6, 7).