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

Collins, Bridget F.; Feemster, Laura C.; Rinne, Seppo T.; Au, David H.

doi:10.1378/chest.14-0672

Cited by 29 publications

(43 citation statements)

References 36 publications

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“…While we did not specifically examine allergic rhinitis, we did not find a higher risk of asthma (another allergic condition) among this group. Our results are also not consistent with a study that found increased body mass index (BMI) to be associated with higher risk of overdiagnosis in veterans [13]. These inconsistencies could be due to differences in populations, the exclusion of nonsmokers and people with asthma in the other studies, how BMI was considered (as a continuous versus categorical variable) and variability in other factors adjusted for.…”

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confidence: 99%

Factors associated with undiagnosed and overdiagnosed COPD

et al. 2016

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Worldwide, studies have shown that about 60-86% of people with chronic obstructive pulmonary disease (COPD) have not been diagnosed, which represents a missed opportunity to decrease disease burden through optimal management, including smoking cessation support and prescription medications [1][2][3]. Overdiagnosed COPD is also common, with prevalence estimates ranging from 4% to 64% in the general population and primary care settings [4,5]. Overdiagnosis can lead to unnecessary COPD treatments with their own risks and costs, poor health-related quality of life and missed detection and treatment of other diseases [6].Misdiagnosed COPD indicates that an inaccurate label has been applied, either by not diagnosing COPD (false negative) or diagnosing COPD in someone who does not have it (false positive). Pulmonary function testing helps to avoid such errors [1]. Previous studies have examined factors that differentiate people with diagnosed COPD (true positives) from people without COPD (true negatives) and from people with undiagnosed COPD (false negatives) [7][8][9]. However, a clinician meeting a patient for the first time would benefit from being aware of factors that differentiate overdiagnosed from correctly diagnosed COPD (false from true positives) and undiagnosed from no COPD (false from true negatives). The objective of the current study was to determine these factors.

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confidence: 99%

Factors associated with undiagnosed and overdiagnosed COPD

et al. 2016

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“…8,18 All patients aged 43 and older with physiciandiagnosed COPD between 2005 and 2012 were identified using a previously validated case-definition of physician-diagnosed COPD: age 35 years and older, and 1 or more COPD-related hospital admission or 3 or more physician COPD ambulatory care visits within 2 years. 19,20 This case definition has a specificity of 95% and a positive predictive value of 81% compared with a clinical reference standard (which may or may not have considered pulmonary function testing).…”

Section: Study Populationmentioning

confidence: 99%

Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Gershon

Mecredy

Croxford

et al. 2016

CMAJ

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BACKGROUND: A small number of people with chronic obstructive pulmonary disease (COPD) receive pulmonary function testing around the time of diagnosis. Because omitting testing increases misdiagnosis, we sought to determine whether health outcomes differed between patients whose COPD was diagnosed with or without pulmonary function testing. METHODS:We conducted a longitudinal population study of patients with physician -diagnosed COPD from 2005 to 2012 using health administrative data from Ontario, Canada. We assessed whether having pulmonary function testing around the time of diagnosis was associated with the composite outcome of admission to hospital for COPD or all-cause death, using adjusted survival analysis.RESULTS: Chronic obstructive pulmonary disease was diagnosed in 68 898 patients during the study period; 41.2% of patients received peridiagnostic pulmonary function testing. In adjusted analysis, patients who underwent testing were less likely to die or be admitted to hospital for COPD (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.89-0.94) and were more likely to be prescribed an inhaled long-acting bronchodilator than patients who did not undergo testing. Subgroup analysis suggested that the association of testing and outcomes was confined to patients with COPD diagnosed in the ambulatory care setting (adjusted HR 0.80, 95% CI 0.76-0.84). INTERPRETATION:Confirmation of a COPD diagnosis using pulmonary function testing is associated with a decreased risk of death and admission to hospital for COPD. In ambulatory patients, this effect may be from increased use of appropriate COPD medications. The findings of this study validate current guideline recommendations that encourage pulmonary function testing for diagnosis in all patients with suspected COPD.

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“…Diagnosing COPD in patients with HF is essential both because dyspnoea in patients with both diseases presents a particular challenge and because the combination of COPD and HF identifies a high-risk population [1–4]. Furthermore can a normal spirometric examination rule-out the coexistence of COPD and other lung disease which might avoid the use of unnecessary medication and help the clinician in focusing on the heart disease [5]. Studies of patients with HF have shown a prevalence of self-reported COPD of 10–33% [1, 3, 6] and studies of spirometry in patients with HF have shown an even higher prevalence of COPD (30–39%).…”

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confidence: 99%

Prevalence of airflow obstruction in patients with stable systolic heart failure

et al. 2017

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BackgroundChronic obstructive pulmonary disease (COPD) is an important differential diagnosis in heart failure (HF). However, routine use of spirometry in outpatient HF clinics is not implemented. The aim of the present study was to determine the prevalence of both airflow obstruction and non obstructive lung function impairment in patients with HF and to examine the effect of optimal medical treatment for HF on lung function parameters.MethodsConsecutive patients with HF (ejection fraction (EF) < 45%) and New York Heart Association (NYHA) functional class II-IV at 10 different outpatient heart failure clinics were examined with spirometry at their first visit and after optimal medical treatment for HF was achieved. airflow obstruction was classified and graded according to the GOLD 2011 revision.ResultsBaseline spirometry was performed in 593 included patients and 71 (12%) had a clinical diagnosis of COPD. Mean age was 69 ± 11 years and mean EF was 30 ± 9%. Thirty-two % of the patients were active smokers and 53% were previous smokers. Mean FEV1 and FVC was 77.9 ± 1.7% and 85.4 ± 1.5% of predicted respectively. Obstructive pattern was observed in 233 (39%) of the patients. Of these, 53 patients (9%) had mild disease (GOLD I) and 180 (30%) patients had moderate to very severe disease (GOLD II-IV). No difference in spirometric variables was observed following up titration of medication.ConclusionIn stable patients with HF airflow obstruction is frequent and severely underdiagnosed. Spirometry should be considered in all patients with HF in order to improve diagnosis and treatment for concomitant pulmonary disease.

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

Cited by 29 publications

References 36 publications

Factors associated with undiagnosed and overdiagnosed COPD

Factors associated with undiagnosed and overdiagnosed COPD

Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Prevalence of airflow obstruction in patients with stable systolic heart failure

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