Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Joo, Min J.; Au, David H.; Fitzgibbon, Marian L.; McKell, Joanne L.; Lee, Todd A.

doi:10.1007/s11606-011-1770-1

Cited by 44 publications

(34 citation statements)

References 30 publications

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“…21 Many providers rely on symptoms to diagnose COPD, even though multiple studies have shown that diagnosis based on symptoms and physical examination is unreliable. 7,[22][23][24] Previous studies have highlighted that only approximately one-third of patients given a new diagnosis of COPD undergo spirometry to verify the diagnosis. 2,6 Studies in primary care physicians suggest that many providers believe that spirometry is not neces sary to diagnose COPD.…”

Section: Discussionmentioning

confidence: 99%

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Factors Predictive of Airflow Obstruction Among Veterans with Presumed Empirical Diagnosis and Treatment of COPD

Collins

Feemster

Rinne

et al. 2015

Chest

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BACKGROUND: Despite guideline recommendations, patients suspected of having COPD oft en are treated empirically instead of undergoing spirometry to confi rm airfl ow 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 confi rmatory spirometry.

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Th is gap between National Quality Forum recommendations and practice is likely driven by attitudes and beliefs about the lack of clinical utility of spirometry in the management of patients with COPD. [7][8][9][10] Empirical…”

mentioning

confidence: 99%

Factors Predictive of Airflow Obstruction Among Veterans with Presumed Empirical Diagnosis and Treatment of COPD

Collins

Feemster

Rinne

et al. 2015

Chest

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“…1 COPD has been estimated to occur in up to 25% of the population aged 40 years and older [1][2][3] ; however, both overdiagnosis and underdiagnosis pose challenges in daily practice, resulting in inappropriate patient management. [2][3][4][5][6][7][8][9][10] COPD guidelines recommend the use of a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) to establish the diagnosis in patients with chronic respiratory symptoms or those at risk. 1,11,12 There is currently no consensus on the best criteria to be used for the spirometric confirmation of a clinical diagnosis of COPD.…”

Section: Introductionmentioning

confidence: 99%

“…1,[11][12][13][14][15][16][17] Prevalence studies have shown discordance between the fixed ratio and LLN, suggesting potential overdiagnosis by the former or underdiagnosis by the latter. 3,4,8,18,19 This controversy persists because of the absence of a reference standard for the diagnosis of COPD. 19 The associations of the 2 criteria with clinical outcomes have been assessed in a few studies, with unclear results on the relative superiority of 1 criterion over the other when it comes to their relationship with different clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Clinical Relevance of Fixed Ratio vs Lower Limit of Normal of FEV1/FVC in COPD: Patient-Reported Outcomes From the CanCOLD Cohort

Dijk

Tan

et al. 2015

The Annals of Family Medicine

103

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PURPOSEThe way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC): the fixed ratio and the lower limit of normal. METHODSWe analyzed data from the cross-sectional phase of the populationbased Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patientreported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations. RESULTSWe analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV 1 , defined as one less than 80% of the predicted value. CONCLUSIONSOur results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV 1 /FVC (according to fixed ratio and/or lower limit of normal) and a low FEV 1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.

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“…Benzer çalışmalarda da, bireylerin BKİ değerleri ile KOAH tanısı almış olma durumları arasında istatistiksel açıdan anlamlı bir ilişki bulunamamıştır. 21 Çalışmamızda, Nevşehir il merkezinde yaşa-yan 40 yaş ve üzeri nüfusta, KHH görülme sıklığı (FEV 1 /FVC<%70) %12,1 olarak tespit edilmiştir (Tablo 4). Liu ve ark.…”

Section: Bulgularunclassified

Incidence of Chronic Airway Diseases and Determination of Risk Factors in Nevşehir Province

Ertürk¹,

Karataş²,

Demir³

2015

Turkiye Klinikleri J Nurs

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Ö ÖZ ZE ET T AAm ma aç ç: : Bu çalışma, Nevşehir ilinde kronik hava yolu hastalıkları (KHH)'nın görülme sıklığı ve risk faktörlerini belirlemek amacıyla planlanmış tanımlayıcı bir araştırmadır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Araştırmanın evrenini, Nevşehir Belediyesi sınırları içerisinde yer alan aile sağlığı merkezleri (ASM)'ne kayıtlı 40 yaş ve üzeri bireyler oluşturmaktadır. Kasım 2010-Mayıs 2011 tarihleri arasında, belirlenen ASM'lere başvuran 630 birey örneklem kapsamına alınmıştır. Çalışmanın yapılabilmesi için Nevsehir İl Sağlık Müdürlüğü izni, etik kurul onayı ve bireylerden yazılı ve sözlü onam alınmıştır. Veriler, bireylerin tanıtıcı özellikleri, KHH risk faktörlerini belirlemeye yönelik oluşturulan anket formları ve solunum fonksiyon testi yapılarak toplanmış-tır. Araştırmadan elde edilen veriler bilgisayar ortamına aktarılmış ve SPSS 15,0 paket programında değer-lendirilmiştir. Veriler ki-kare, Mann-Whitney U ve bağımsız örneklemde t-Testi kullanılarak değerlendirilmiştir. İstatistiksel olarak farkın önemliliği p<0,05 olarak kabul edilmiştir. B Bu ul lg gu ul la ar r: : Çalışmaya katılan bireylerin, %54,1'i kadın, %45,3'ü 40-49 yaş grubunda ve %34.1'i halen sigara içmektedir. Erkeklerde sigara kullanımı daha fazladır. Araştırmaya katılan bireylerin %12,1'inde obstrüksiyon (FEV 1 /FVC<%70) tespit edilmiştir. FEV 1 /FVC<%70 saptanan bireylerin FEV 1 %, PEF % ve FEF 25-75% değerleri, FEV 1 /FVC<%70 tespit edilmeyen bireylere göre daha düşük ve aralarındaki fark istatistiksel açıdan anlamlı bulunmuştur (p=0,001). Beden kitle indeksi ve obstrüksiyon arasında anlamlılık saptanmamıştır (p=0,132). Gelir durumu gider durumuna göre düşük olan, tozlu, dumanlı ve gazlı ortamlarda çalışan ve kerpiç evde yaşayan bireylerde obstrüksiyon görülme sıklığı daha fazla olarak saptanmıştır. S So on nu uç ç: : Nevşehir il merkezinde KHH görülme sıklığı %12,1 tespit edilmiştir. Bu sonuçlar doğrultusunda birinci basamak sağlık kuruluşlarında hastalığın erken tespiti için solunum fonksiyon testi yapılması ve ülke çapında KHH prevalansının belirlenmesi için bölgesel çalışmaların planlanması önerilmektedir.A An na ah ht ta ar r K Ke el li im me el le er r: : Akciğer hastalıkları, tıkayıcı; akciğer hastalıkları A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The present research was a descriptive research planned to determine chronic airway diseases (CAD) and risk factors in Nevşehir. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The population of the research was consisted of individuals aged ≥40 who were registered at the family health centers (FHC) located in Nevsehir city center. The sample included 630 individuals who visited FHCs and were selected using random number table between October 2010 and May 2011. Official permissions from Nevsehir Health Directorate, approval of ethical committee and the oral and written consents of the participants were obtained in order to conduct the research. The data were collected using questionnaire forms to find out descriptive characteristics...

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Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Cited by 44 publications

References 30 publications

Factors Predictive of Airflow Obstruction Among Veterans with Presumed Empirical Diagnosis and Treatment of COPD

Factors Predictive of Airflow Obstruction Among Veterans with Presumed Empirical Diagnosis and Treatment of COPD

Clinical Relevance of Fixed Ratio vs Lower Limit of Normal of FEV1/FVC in COPD: Patient-Reported Outcomes From the CanCOLD Cohort

Incidence of Chronic Airway Diseases and Determination of Risk Factors in Nevşehir Province

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