0
Correspondence |

Underutilization of Spirometry for the Diagnosis of COPDResponse FREE TO VIEW

Mirco Lusuardi, MD; Danilo Orlandini, MD
Author and Funding Information

Affiliations: Azienda Unità Sanitaria Locale Reggio Emilia, Correggio, Italy,  Division of Pulmonary and Critical Care Medicine, University of Michigan

Correspondence to: Mirco Lusuardi, MD, San Sebastiano Hospital, Cardiopulmonary Rehabilitation, via Mandriolo 11, Correggio, Reggio Emilia 42015, Italy; e-mail: lusuardimi@ausl.re.it



Chest. 2008;133(1):313-314. doi:10.1378/chest.07-2172
Text Size: A A A
Published online

The interesting article in CHEST (August 2007) by Han et al1and the relative editorial comment2 stressed the problem of COPD diagnosis, which by definition must be confirmed by spirometry, but which in clinical practice is based only on clinical grounds in a large proportion of cases. The negative consequences, such as the overadministration of therapies, with the chance of doing more harm than good in terms of costs and number of adverse events, have been correctly underlined. The authors reported no difference between the primary care and the specialist setting, while other published articles have reported that specialists are more likely to use spirometry.

The Clinical Effectiveness Unit of the Public Local Health Authority of the province of Reggio Emilia (Italy) [population of about 500,000] conducted an audit study in its four general hospital and one rehabilitation hospital to verify whether or not the diagnosis of COPD was correctly supported by spirometry. Taking a 2-year period into account (from 2005 to 2006), 379 clinical records were selected with a first diagnosis of COPD coded according to the International Classification of Diseases (ninth revision) as 49120, 49121, or 51881 (respiratory failure), with 49120 or 49121 as a second diagnosis. The mean percentage of COPD diagnoses supported by spirometry was 19.3%; interestingly enough, however, there were large variations according to the organization of hospital units. In our only Pulmonary Rehabilitation Unit, clinical records documented the use of spirometry in 46.1% of cases, while in the pulmonary services within internal medicine departments documentation of the use of spirometry was present in 14.4% of cases (range, 9.2 to 26.0%). Since our hospitals refer respiratory problems to pulmonologists of similar experience, it is evident that the organization and operational context may play a significant role, as demonstrated in the literature in relation to survival and length of hospital stay.34

In the editorial comment, our article (ie, Lusuardi et al5) was kindly quoted as an example of the potential overutilization of office spirometry in COPD diagnosis. Actually, the real conclusions of the study were rather disappointing with regard to the regular use of spirometry in primary care, and one detail from the final conclusions of the study should be underlined: the use of a questionnaire was comparable to office spirometry in identifying the patients with the highest probability of a COPD or asthma diagnosis, which is exactly in line with the recommendations of Enright and Quanjer.2

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

The authors have no conflicts of interest to disclose.

Han, MLK, Kim, MG, Mardon, R, et al (2007) Spirometry utilization for COPD: how do we measure up?Chest132,403-409. [PubMed] [CrossRef]
 
Enright, P, Quanjer, P Spirometry for COPD is both underutilized and overutilized.Chest2007;132,368-369. [PubMed]
 
Roberts, CM, Barnes, S, Lowe, D, et al Evidence of a link between mortality in acute COPD and hospital type and resources.Thorax2003;58,947-949. [PubMed]
 
Price, LC, Lowe, D, Hosker, H, et al The UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admissions for acute COPD exacerbation.Thorax2006;61,837-842. [PubMed]
 
Lusuardi, M, De Benedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice.Chest2006;129,844-852. [PubMed]
 
To the Editor:

We thank Drs. Lusuardi and Orlandini for their comment on our recent article,1in which they highlight the poor overall usage of spirometry seen in both the primary care and specialty settings in our study. They also report data that they have collected suggesting spirometry utilization varies by practice setting, with patients being cared for in a pulmonary rehabilitation unit having received significantly more documented spirometry than patients being cared for on pulmonary services within internal medicine departments. As we point out in our article, our data may have been biased by the fact that pulmonologists were not separated from other specialists. Several other reports23 have suggested higher spirometry utilization among pulmonologists. We also appreciate the comments regarding the letter writers’ own study4 that failed to find a significant advantage to office spirometry in the general practice setting to improve the diagnosis of asthma and COPD, highlighting the need to identify appropriate patients for testing and for general practitioners and pulmonologists to work together.

References
Han, MK, Kim, MG, Mardon, R, et al Spirometry utilization for COPD: how do we measure up?Chest2007;132,403-409. [PubMed] [CrossRef]
 
Lee, TA, Bartle, B, Weiss, KB Spirometry use in clinical practice following diagnosis of COPD.Chest2006;129,1509-1515. [PubMed]
 
Barr, RG, Celli, BR, Martinez, FJ, et al Physician and patient perceptions in COPD: the COPD Resource Network Needs Assessment Survey.Am J Med2005;118,1415
 
Lusuardi, M, De Benedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from Spirometry in Asthma and COPD; a comparative evaluation Italian study.Chest2006;129,844-852. [PubMed]
 

Figures

Tables

References

Han, MLK, Kim, MG, Mardon, R, et al (2007) Spirometry utilization for COPD: how do we measure up?Chest132,403-409. [PubMed] [CrossRef]
 
Enright, P, Quanjer, P Spirometry for COPD is both underutilized and overutilized.Chest2007;132,368-369. [PubMed]
 
Roberts, CM, Barnes, S, Lowe, D, et al Evidence of a link between mortality in acute COPD and hospital type and resources.Thorax2003;58,947-949. [PubMed]
 
Price, LC, Lowe, D, Hosker, H, et al The UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admissions for acute COPD exacerbation.Thorax2006;61,837-842. [PubMed]
 
Lusuardi, M, De Benedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice.Chest2006;129,844-852. [PubMed]
 
Han, MK, Kim, MG, Mardon, R, et al Spirometry utilization for COPD: how do we measure up?Chest2007;132,403-409. [PubMed] [CrossRef]
 
Lee, TA, Bartle, B, Weiss, KB Spirometry use in clinical practice following diagnosis of COPD.Chest2006;129,1509-1515. [PubMed]
 
Barr, RG, Celli, BR, Martinez, FJ, et al Physician and patient perceptions in COPD: the COPD Resource Network Needs Assessment Survey.Am J Med2005;118,1415
 
Lusuardi, M, De Benedetto, F, Paggiaro, P, et al A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from Spirometry in Asthma and COPD; a comparative evaluation Italian study.Chest2006;129,844-852. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543