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Original Research: COPD |

The Association of Weight With the Detection of Airflow Obstruction and Inhaled Treatment Among Patients With a Clinical Diagnosis of COPDBMI, Airflow Obstruction, Inhaled Therapy in COPD

Bridget F. Collins, MD; David Ramenofsky, MD; David H. Au, MD; Jun Ma, MD, PhD; Jane E. Uman, MPH; Laura C. Feemster, MD
Author and Funding Information

From Health Services Research and Development (Drs Collins, Au, and Feemster and Ms Uman), Department of Veterans Affairs, Seattle, WA; Division of Pulmonary and Critical Care (Drs Collins, Ramenofsky, Au, and Feemster), Department of Medicine, University of Washington, Seattle, WA; and Department of Health Services Research (Dr Ma), Palo Alto Medical Foundation Research Institute, and Stanford Prevention Research Center (Dr Ma), Stanford University School of Medicine, Palo Alto, CA.

CORRESPONDENCE TO: Bridget F. Collins, MD, Health Services Research and Development, Department of Veterans Affairs, Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98101; e-mail: bfc3@uw.edu


FOR EDITORIAL COMMENT SEE PAGE 1426

Part of this article has been presented in thematic poster form at the American Thoracic Society International Conference, May 17-20, 2013, Philadelphia, PA.

FUNDING/SUPPORT: This study was funded by an American Lung Association Career Investigator Award [CI-51755N]. Dr Collins is supported by the National Institutes of Health (NIH) [Training Grant T32-HL-007287]. Dr Au is supported by the Department of Veterans Affairs, Health Services Research and Development. Dr Ma is supported through internal funding from the Palo Alto Medical Foundation Research Institute. Dr Feemster was previously supported by the Department of Veterans Affairs, Health Services Research and Development, and is currently funded by an NIH National Heart, Lung, and Blood Institute K23 Mentored Career Development Award.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):1513-1520. doi:10.1378/chest.13-2759
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BACKGROUND:  Most patients with a clinical diagnosis of COPD have not had spirometry to confirm airflow obstruction (AFO). Overweight and obese patients report more dyspnea than normal weight patients, which may be falsely attributed to AFO. We sought to determine whether overweight and obese patients who received a clinical diagnosis of COPD were more likely to receive a misdiagnosis (ie, lack of AFO on spirometry) and be subsequently treated with inhaled medications.

METHODS:  The cohort comprised US veterans with COPD (International Classification of Diseases, 9th Revision, code; inhaled medication use; or both) and spirometry measurements from one of three Pacific Northwest Veterans Administration Medical Centers. The measured exposures were overweight and obesity (defined by BMI categories). Outcomes were (1) AFO on spirometry and (2) escalation or deescalation of inhaled therapies from 3 months before spirometry to 9 to 12 months after spirometry. We used multivariable logistic regression with calculation of adjusted proportions for all analyses.

RESULTS:  Fifty-two percent of 5,493 veterans who had received a clinical diagnosis of COPD had AFO. The adjusted proportion of patients with AFO decreased as BMI increased (P < .01 for trend). Among patients without AFO, those who were overweight and obese were less likely to remain off medications or to have therapy deescalated (adjusted proportions: normal weight, 0.69 [95% CI, 0.64-0.73]; overweight, 0.62 [95% CI, 0.58-0.65; P = .014]; obese, 0.60 [95% CI, 0.57-0.63; P = .001]).

CONCLUSIONS:  Overweight and obese patients are more likely to be given a misdiagnosis of COPD and not have their inhaled medications deescalated after spirometry demonstrated no AFO. Providers may be missing potential opportunities to recognize and treat other causes of dyspnea in these patients.

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