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

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aPulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC

bPulmonary, Critical Care, and Sleep Disorders Medicine, George Washington University, Washington, DC

cPulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD

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


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1397-1398. doi:10.1016/j.chest.2017.02.031
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We appreciate the interest and observations of Dr Lopez-Campos et al regarding our article recently published in CHEST on spirometric confirmation of COPD in patients hospitalized for COPD exacerbation.

Having used an electronic medical record for 20 years, the Veterans Healthcare System data bank allows simpler methods. Stored individual medical records of inpatient and outpatient service include discrete spirometric measurements. All spirometry is performed in a central pulmonary function testing laboratory by trained certified pulmonary function testing technicians under the direction of pulmonary physicians, with each test reviewed by a senior pulmonary physician before release. Each enrolled patient had a unique identifier that allowed synchronization of information between clinical and spirometric databases. Readmissions were readily identified and eliminated by using the unique identifiers.

The European COPD Audit was the first European transnational prospective audit of COPD care and required highly complex methodology to collect, protect, and incorporate data across differing health-care systems, countries, and languages, most without electronic medical records, which is different from our study. We are interested to note that the European COPD Audit revealed remarkably similar rates of spirometric confirmation of COPD (51.2% vs 52.9%) and of finding no airflow obstruction on spirometry (7.7% vs 8.2%) compared with our findings.

Since the online publication of our study, the 2017 revision of the Global Initiative on Obstructive Lung Disease standards and recommendations has been released. The revised Global Initiative on Obstructive Lung Disease ABCD assessment tool emphasizes hospitalization history and symptoms rather than FEV1/FVC to manage individual treatment. Chronic respiratory symptoms may precede the development of airflow limitation and may be associated with acute respiratory events and hospitalization. Nevertheless, spirometry is a key element for differential diagnosis of chronic dyspnea and prognosis of COPD. Every patient with a clinical diagnosis of COPD needs to undergo spirometry.

References

Wu H. .Wise R.A. .Medinger A.E. . Do patients hospitalized with COPD have airflow obstruction? Chest. 2017;151:1263-1271 [PubMed]journal
 
López-Campos J.L. .Hartl S. .Pozo-Rodriguez F. .Roberts C.M. . European COPD Audit Team. European COPD Audit: design, organisation of work and methodology. Eur Respir J. 2013;41:270-276 [PubMed]journal. [CrossRef] [PubMed]
 
Vogelmeier C.F. .Criner G.J. .Martinez F.J. .et al Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195:557-582 [PubMed]journal. [CrossRef] [PubMed]
 
Woodruff P.G. .Barr R.G. .Bleecker E. .et al Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374:1811-1821 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Wu H. .Wise R.A. .Medinger A.E. . Do patients hospitalized with COPD have airflow obstruction? Chest. 2017;151:1263-1271 [PubMed]journal
 
López-Campos J.L. .Hartl S. .Pozo-Rodriguez F. .Roberts C.M. . European COPD Audit Team. European COPD Audit: design, organisation of work and methodology. Eur Respir J. 2013;41:270-276 [PubMed]journal. [CrossRef] [PubMed]
 
Vogelmeier C.F. .Criner G.J. .Martinez F.J. .et al Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195:557-582 [PubMed]journal. [CrossRef] [PubMed]
 
Woodruff P.G. .Barr R.G. .Bleecker E. .et al Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374:1811-1821 [PubMed]journal. [CrossRef] [PubMed]
 
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