Perseverant, non-indicated treatment of obese patients for obstructive lung disease

Abstract

BackgroundBronchodilators are a mainstay of treatment for patients with airflow obstruction. We hypothesized that patients with obesity and no objective documentation of airflow obstruction are inappropriately treated with bronchodilators.MethodsSpirometric results and medical records of all patients with body mass index >30 kg/m2 who were referred for testing between March 2010 and August 2011 were analyzed.Results155 patients with mean age of 52.6 ± (SE)1.1 y and BMI of 38.7 ± 0.7 kg/m2 were studied. Spirometry showed normal respiratory mechanics in 62 (40%), irreversible airflow obstruction in 36 (23.2%), flows suggestive of restriction in 35 (22.6%), reversible obstruction, suggestive of asthma in 11 (7.1%), and mixed pattern (obstructive and restrictive) in 6 (3.9%). Prior to testing, 45.2% (28 of 62) of patients with normal spirometry were being treated with medications for obstructive lung diseases and 33.9% (21 of 62) continued them despite absence of airflow obstruction on spirometry. 60% (21 of 35) of patients with a restrictive pattern in their spirometry received treatment for obstruction prior to spirometry and 51.4% (18 of 35) continued bronchodilator therapy after spirometric testing. There was no independent association of non-indicated treatment with spirometric results, age, BMI, co-morbidities or smoking history. All patients with airflow obstruction on testing who were receiving bronchodilators before spirometry continued to receive them after testing.ConclusionA substantial proportion of patients with obesity referred for pulmonary function testing did not have obstructive lung disease, but were treated nonetheless, before and after spirometry demonstrating absence of airway obstruction.

Prise en charge non invasive de l’insuffisance respiratoire aiguë de l’obèse morbide

“…Notre équipe a récemment montré que seule la position assise (inclinée à 70°) permettait de faire disparaître la LDE et d'annuler l'auto-PEEP chez la plupart des patients obèses morbides en ventilation mécanique [17]. Elle pourrait donc éviter le recours inutile à des thérapeutiques (corticoïdes, bêta-2-mimétiques à fortes doses…) inefficaces et risquées chez les obèses en IRA [7]. En diminuant de façon majeure les pressions intrathoraciques [17], la position assise allège le travail respiratoire et cardiaque que ce soit en ventilation spontanée [14] ou sous ventilation mécanique [17].…”

“…L'insuffisance respiratoire aiguë (IRA) en est un mode de révélation fréquent [4,5]. Mais trop souvent ces patients sont diagnostiqués à tort comme asthmatiques, insuffisants cardiaques ou BPCO et vont recevoir des théra-peutiques inappropriées, voire dangereuses [6,7]. La bonne connaissance des mécanismes physiologiques participant à l'IRA de l'obèse permet de dépister précocement ces patients et d'adapter au mieux leur traitement.…”

Inhaled Medication Use in Smokers With Normal Spirometry

“…In a retrospective study at a small community hospital, inhaled medications were prescribed to 45% and 60% of individuals with normal spirometry and preserved ratio impaired spirometry (restrictive pattern), respectively. 6 In another single-center study among subjects undergoing a pulmonary function test for various clinical reasons (eg, dyspnea) and showing no obstructive defect, about one quarter of them continued to be prescribed inhaled medications at 6 months following the pulmonary function test. Increasing age and smoking history are factors associated with empiric use of inhaled medications.…”

Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction

“…2 Even after a PFT shows no obstruction, physicians often continue to empirically treat individuals with medications like bronchodilators. 3,5 Persistent empiric COPD diagnosis and treatment after the PFT has shown no obstruction have not been well described. 3,5 Previous studies may have overestimated empiric COPD and treatment because they used only spirometric criteria, although FEV 1 /FVC Ն lower limit of normal alone is not sufficient to rule out COPD.…”

“…3,5 Persistent empiric COPD diagnosis and treatment after the PFT has shown no obstruction have not been well described. 3,5 Previous studies may have overestimated empiric COPD and treatment because they used only spirometric criteria, although FEV 1 /FVC Ն lower limit of normal alone is not sufficient to rule out COPD. Often in COPD, FEV 1 may be reduced concomitantly with FVC, and the ratio may appear normal.…”