Obstructive Lung Diseases |

Spirometry Interpretation and the Potential Risk of Misdiagnosis FREE TO VIEW

Stephen Doyle, DO; Heath Latham, MD
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University of Kansas, Kansas City, MO

Chest. 2015;148(4_MeetingAbstracts):706A. doi:10.1378/chest.2275124
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: COPD is the 3rd leading cause of death in the United States and carries significant morbidity. The Global Initiative for Chronic Obstructive Lung disease (GOLD) was developed to help guide treatment for this disease. The 2013 GOLD update recommends pulmonary function tests (PFTs) be obtained in order to accurately diagnosis COPD. In addition, GOLD guidelines recommend annual PFTs to track stability and guide therapy. Implementation of GOLD guidelines has been shown to reduce exacerbations, improve lung function, and quality of life markers in patients with COPD. This study investigated the use of spirometry to confirm the diagnosis of COPD and the appropriateness of therapy in those with the clinical diagnosis of COPD.

METHODS: After IRB approval, a retrospective chart review was performed on 136 patients identified based on visit diagnosis codes related to COPD in an Internal Medicine resident clinic at an academic medical center between September 2013 and August 2014. Measures included documentation of initial PFTs, PFTs performed in the prior year, FEV1/FVC ratio, FEV1, and medications prescribed. Data was organized and analyzed by REDCap software.

RESULTS: Results showed 30% of patients never underwent spirometry to confirm a diagnosis of COPD, yet still were labelled with the diagnosis of COPD. Seventy percent of patients had documented PFTs, and 62% had PFTs in the past calendar year. Thirty six percent of patients had an FEV1/FVC ratio greater than 70% and by spirometric definition do not meet criteria for COPD. In addition, 54% of those inappropriately diagnosed received oral steroids for an exacerbation. There appeared to be a bias against smokers as 79% of those with a normal ratio received treatment with oral steroids.

CONCLUSIONS: In our study, the percent of patients with documented spirometry was better than recent trials showing only 33% to 50% of people with COPD had spirometry to confirm the diagnosis. Similar to recent studies, we found a significant portion of patients being labelled with COPD without supporting spirometry and unfortunately receiving therapy for a disease process they did not have. To our knowledge, this is the first study investigating the inappropriate use of systemic steroids in those misdiagnosed with COPD.

CLINICAL IMPLICATIONS: Systemic steroids have many well documented adverse effects. By not performing spirometry prior to treatment, patients can be subjected to these potentially harmful effects.

DISCLOSURE: The following authors have nothing to disclose: Stephen Doyle, Heath Latham

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