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Original Research: COPD |

Factors Predictive of Airflow Obstruction Among Veterans With Presumed Empirical Diagnosis and Treatment of COPDAirflow Obstruction in Clinically Diagnosed COPD

Bridget F. Collins, MD; Laura C. Feemster, MD; Seppo T. Rinne, MD, PhD; David H. Au, MD
Author and Funding Information

From Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System; and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA.

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 284

FUNDING/SUPPORT: This study was funded by an American Lung Association Career Investigator Award [CI-51755N]. Drs Collins and Rinne are supported by National Institutes of Health (NIH) [Training Grant T32 HL007287]. Dr Feemster is funded by an NIH National Heart, Lung, and Blood Institute K23 Mentored Career Development Award [K23 HL111116] and by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D). Dr Au is supported by the VA HSR&D.

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


Chest. 2015;147(2):369-376. doi:10.1378/chest.14-0672
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BACKGROUND:  Despite guideline recommendations, patients suspected of having COPD often are treated empirically instead of undergoing spirometry to confirm airflow obstruction (AFO). Accurate diagnosis and treatment are essential to provide high-quality, value-oriented care. We sought to identify predictors associated with AFO among patients with and treated for COPD prior to performance of confirmatory spirometry.

METHODS:  We identified a cohort of veterans with spirometry performed at Pacific Northwest Department of Veterans Affairs medical centers between 2003 and 2007. We included only patients with empirically diagnosed COPD in the 2 years prior to spirometry who were also taking inhaled medication to treat COPD in the 1 year prior to spirometry. We used relative risk regression analysis to identify predictors of AFO.

RESULTS:  Among patients empirically treated for COPD (N = 3,209), 62% had AFO. Risk factors such as older age, prior smoking status, and underweight status were associated with AFO on spirometry. In contrast, comorbidities often associated with somatic symptoms were associated with absence of AFO and included congestive heart failure, depression, diabetes, obesity, and sleep apnea.

CONCLUSIONS:  Comorbidities associated with somatic complaints of dyspnea were associated with a lower risk of having airflow limitations, suggesting that empirical diagnosis and treatment of COPD may lead to inappropriate treatment of individuals who do not have AFO.

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