Obstructive Lung Diseases |

Spirometry Utilization in COPD; One Health System's Experience FREE TO VIEW

Bohdan Pichurko, MD; Kevin McCarthy, RPFT
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Cleveland Clinic, Mentor, OH

Chest. 2015;148(4_MeetingAbstracts):692A. doi:10.1378/chest.2281089
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SESSION TYPE: Original Investigation Poster

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

PURPOSE: Assess the rate of compliance with the ATS/ERS recommendation1 that the clinical diagnosis of COPD be confirmed by spirometric confirmation of obstruction that is not fully reversed by bronchodilators.

METHODS: The electronic medical record was queried for all outpatients seen in the Cleveland Clinic Health System during the study period between 7/1/13 and 8/1/1/4 with an ICD9 code of 490-2, 494 or 496. The resultant table was matched against the PFT database for any spirometry test between 7/1/96 and 2/28/15.

RESULTS: 5,137 unique patients made 15,943 outpatient visits during the study period with the COPD ICD-9 codes. Males were 47.1%, females 52.9% of the cohort. Caucasians comprised 77.6%, African Americans 19.1%, other/undefined were 3.3%. Mean age was 65.2 +12.4 years. Only 669 patients (13.0%) with COPD diagnosis had spirometry in the time period 12 months prior to 6 months after the visit during the study period. Of these, only 316 (47.2%) had a post-bronchodilator assessment. An additional 1,925 patients had a spirometry test more than 12 months before the outpatient visit during the study period. Obstruction (FVC > LLN, ratio < LLN), n=53 (7.9%) Restriction suggested (FVC < LLN, ratio > LLN), n=165 (24.7%) Combined (FVC< LLN, ratio < LLN), n=431 (64.4%) Normal (FVC > LLN, ratio > LLN), n=20 (3.0%) Severity: Mild 12.1%, Moderate 14.3%, Moderately Severe 14.9%, Severe:19.8%, Very Severe: 38.8%

CONCLUSIONS: Making the diagnosis of COPD without spirometric confirmation of obstruction is common. Even when spirometry was done, it was often not done annually to assess the patient's current severity. Nearly 30% of the patients in this cohort did not demonstrate obstruction on spirometry. Most of these showed results suggesting restriction making the diagnosis of COPD unlikely.

CLINICAL IMPLICATIONS: 1. Low rate of utilization of PFT’s continues to be the observed norm. 2. Absence of PFT data limits information regarding severity and response to treatment in COPD 3. Potentially greater significance lies in the incorrect diagnosis and thus unnecessary treatment with associated morbidity and cost. 4. Dyspnea - producing disorders that mimic COPD - eg diastolic LV dysfunction, glottic disorders, will remain undiagnosed and untreated , posing risk to the patient. References: 1. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932-946.

DISCLOSURE: The following authors have nothing to disclose: Bohdan Pichurko, Kevin McCarthy

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