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Original Research |

Do patients hospitalized with COPD have airflow obstruction?

Huimin Wu, MD; Robert A. Wise, MD; Ann E. Medinger, MD
Author and Funding Information

Dr. Huimin Wu has no conflict of interest regarding the publication of this paper.

Dr. Robert Wise has no conflict of interest regarding the publication of this paper.

Dr. Ann Medinger has no conflict of interest regarding the publication of this paper.

Funding/Support: No

1Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington DC 20422

2Pulmonary, Critical Care, and Sleep Disorders Medicine, The George Washington University, Washington DC 20037

3Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21224

Corresponding author: Huimin Wu, MD. Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.003
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Published online

Abstract

Background  Guidelines recommend the confirmation of a COPD diagnosis with spirometry. ICD-9-CM diagnostic codes are used frequently to identify patients with COPD for administrative purposes. However, coding the diagnosis of COPD does not require spirometric confirmation. The purpose of this study was to determine how often the discharge diagnoses of COPD is supported by spirometric measurements in the VA health system.

Methods  We reviewed records of patients hospitalized for COPD in a VA teaching hospital between 2005 and 2015. Individuals were counted once; rehospitalizations for COPD in the same time frame were excluded. Patients’ records were assessed for presence of spirometric measurements and for spirometric evidence of COPD.

Results  There were 1278 discharges with the principal diagnosis of COPD and allied conditions in the time frame. A total of 826 discharged-patients were included. Among them, 21% had no spirometric measurements, 12% were unable to perform the breathing maneuvers correctly, 56% had spirometric evidence of airways obstruction and 11% had normal pre or post bronchodilator FEV1/FVC measurements. Older patients were more likely to fail the spirometry or have no documented spirometry. Younger patients were more likely to have the first spirometry after their COPD hospitalizations.

Conclusions  Caution must be taken when using the discharge diagnosis database to measure health care outcomes and determine resource management. Efforts are needed to assure that patients clinically suspected to have COPD are tested with spirometry to improve the accuracy of diagnosis of COPD.


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