Chronic Obstructive Pulmonary Disease (COPD) represents a major public health burden, with significant implications for healthcare systems in terms of clinical outcomes, therapeutic appropriateness, and resource allocation. In Italy, suboptimal use of spirometry in primary care contributes to both underdiagnosis and overdiagnosis, leading to inappropriate treatment and inefficiencies within the National Health Service (Servizio Sanitario Nazionale, SSN).

To assess whether the integration of structured spirometry-based diagnostic pathways within primary care networks (Aggregazioni Funzionali Territoriali – AFTs) improves diagnostic accuracy, therapeutic appropriateness, and healthcare governance.

A comparative observational analysis was conducted using anonymized and aggregated clinical data derived from electronic medical records of approximately 30,000 patients across three AFTs in the Campania region, Italy. Data access and processing were performed in compliance with the European General Data Protection Regulation (GDPR) and Italian rules applicable to retrospective observational analyses; no identifiable patient-level information was used. COPD diagnosis was identified based on a combination of clinical records, diagnostic coding when available, treatment records, and spirometric evidence of airflow limitation when performed. One AFT included a dedicated COPD clinic with in-house spirometry, while two AFTs followed standard care pathways.

In the standard AFTs, COPD diagnosis lacked spirometric confirmation in up to 70% of cases, suggesting substantial diagnostic inappropriateness. Conversely, the AFT with a dedicated clinic demonstrated higher spirometry utilization (80% vs. 30–35%), improved diagnostic accuracy, and more appropriate prescribing patterns. This model was associated with reduced unnecessary specialist referrals, lower emergency department use, and improved patient engagement, particularly regarding smoking cessation counseling.

The integration of spirometry within primary care represents a scalable strategy to enhance diagnostic and therapeutic appropriateness, improve healthcare governance, and support the sustainability of the Italian SSN. This approach also enables longitudinal monitoring of lung function and early identification of high-risk populations, contributing to better clinical and socioeconomic outcomes.