Office Spirometry in Primary Care for the Diagnosis and Management of COPD: National Lung Health Education Program Update

Ruppel, Gregg; Carlin, Brian; Hart, Mary; Doherty, Dennis E.

doi:10.4187/respcare.05710

Cited by 29 publications

(31 citation statements)

References 80 publications

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“…This was also based on recommendations made by the American Thoracic Society/European Respiratory Society and others in the field. 20 Many others advocate using the lower limit of normal standard because the GOLD standard can lead to misclassification of COPD, especially when used in an elderly population, as is often seen with COPD. [21][22][23] A number of our subjects diagnosed with COPD did not have spirometry data in their records.…”

Section: Discussionmentioning

confidence: 99%

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

2020

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BACKGROUND: Although specific guidelines exist for diagnosing COPD on the basis of spirometry testing data (FEV 1 /FVC < 0.70 or above the lower limit of normal), the literature suggests that overdiagnosis is common. Whether overdiagnosis increases 30-d readmission rates has not yet been explored. The objective of this study was to determine the prevalence of COPD overdiagnosis and its effect on 30-d hospital readmission rates in our institution. METHODS: We retrospectively identified all subjects who were coded with a COPD hospital discharge in 2018 at Cleveland Clinic main campus and had spirometry data available, including FEV 1 and FVC. FEV 1 /FVC was calculated and compared with the predicted lower limit of normal values. Hospital discharge diagnosis and 30-d hospital readmission data were captured along with comorbidities and other demographics. RESULTS: In 2018, there were 424 hospital discharges with a COPD diagnosis with spirometry testing available. Of these subjects, 124 (29%) were overdiagnosed in the lower limit of normal group and 99 (23.3%) were in the 6 0.70 group. One hundred subjects (23.6%) had a 30-d hospital readmission. Of these subjects, 35 had FEV 1 /FVC that was greater than their predicted lower limit of normal on spirometry. Of the 324 subjects who were not readmitted within 30 d, 89 (27.5%) had FEV 1 /FVC greater than the lower limit of normal. If the 35 readmitted subjects had not been coded with COPD, the 30-d readmission rate would have decreased significantly from 23.6% to 16.7% (100 of 424 vs 65 of 389, P 5 .01). Even if all of the 124 subjects who had pulmonary function test data greater than the lower limit of normal had not been counted, the readmission rate would still have decreased from 23.6% to 21.7%, but this was not significant (from 100 of 424 to 65 of 300, P 5 .3). CONCLUSIONS: COPD was overdiagnosed in our cohort of subjects; this was true whether the FEV 1 /FVC < 0.70 standard or the lower limit of normal standard was used. Furthermore, this overdiagnosis artificially inflated the 30-d readmission rate. These results illustrate the caution providers should use when making a COPD diagnosis.

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Section: Discussionmentioning

confidence: 99%

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

2020

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“…Desde então, a utilização da espirometria aumentou, mas seu papel no diagnóstico da DPOC ainda está evoluindo. Os valores de FEF 25%-75% menores que 65% do valor previsto devem ser considerados como biomarcadores para diagnóstico funcional e controle terapêutico da asma e DPOC 16 .…”

Section: Considerações Finais E Perspectivas Futurasunclassified

As pequenas vias aéreas na doença pulmonar obstrutiva crônica

Furtado

Lima

Cardenas

et al. 2019

Rev. Med. (São Paulo)

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De acordo com a Organização Mundial da Saúde, a doença pulmonar obstrutiva crônica (DPOC) foi a quarta causa de morte em todo o mundo em 2012. O distúrbio das pequenas vias aéreas é um elemento importante na DPOC. O estreitamento das pequenas vias aéreas é a causa principal de aumento da resistência do fluxo de ar na DPOC. Há evidências que lesões das vias aéreas pequenas ocorrem no início da história natural da DPOC. Assim, é importante que a espirometria e outros testes, como a oscilometria de impulso, sejam usados para o diagnóstico de doenças das pequenas vias aéreas. No laudo de espirometria, as medidas do fluxo expiratório médio máximo (MMEF25%-75% ou FEF25%-75%) devem ser consideradas usando as variáveis primárias, após diagnosticada ausência de obstrução. Se a relação VEF1 /CVF% for limítrofe, uma redução no MMEF25%-75% ou outros fluxos terminais corrigidos para a capacidade vital forçada ou também o tempo expiratório forçado elevado, diagnosticam a obstrução do fluxo em pequenas vias aéreas em indivíduos respiratórios sintomáticos.

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“…Spirometry testing plays an important role in the diagnosis and management of Chronic Obstructive Pulmonary Disease (COPD) and asthma [1–3]. In addition, a restrictive spirometry pattern can prompt additional testing (e.g., lung volumes, diffusing capacity) to diagnose restrictive abnormalities like interstitial lung disease [4].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a restrictive spirometry pattern can prompt additional testing (e.g., lung volumes, diffusing capacity) to diagnose restrictive abnormalities like interstitial lung disease [4]. The clinical impact of spirometry data on patient care is considerable; however, primary care providers must be able to interpret spirometry testing accurately [3, 4]. Spirometry interpretation is not limited to evaluating physiologic patterns, but also pre-test procedures and test quality.…”

Section: Introductionmentioning

confidence: 99%

Basic spirometry testing and interpretation for the primary care provider

Haynes¹

2018

CJRT

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Spirometry testing plays an important role in the diagnosis and management of COPD and asthma in the primary care setting. Verifying the accuracy of the spirometer, using accurate patient demographics and appropriate reference equations, and ensuring the competency of testing personnel are key components of spirometry test interpretation. Spirometry testing plays an important role in the diagnosis and management of lung disease in the primary care setting. Spirometry interpretation should include an assessment of test quality and be based on sound statistical principals.

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Office Spirometry in Primary Care for the Diagnosis and Management of COPD: National Lung Health Education Program Update

Cited by 29 publications

References 80 publications

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

As pequenas vias aéreas na doença pulmonar obstrutiva crônica

Basic spirometry testing and interpretation for the primary care provider

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