Chest
Original Research: COPDFactors Predictive of Airflow Obstruction Among Veterans with Presumed Empirical Diagnosis and Treatment of COPD
Section snippets
Study Design, Setting, and Subjects
We used data collected from a cohort of US veterans receiving care at one of three Pacific Northwest Department of Veterans Affairs (VA) medical centers. We identified patients who had their first spirometry between January 2003 and December 2007. The index date was defined as the date of first spirometry. The Institutional Review Board of the VA Puget Sound Healthcare System approved this study (IRB project approval number 01386).
Description of the Cohort
There were 14, 541 veterans who had spirometry at one of three VA medical centers during the study period, 5, 148 (35.4%) of whom had a prior diagnosis of COPD. Among patients with a clinical diagnosis of COPD, approximately one-half (n = 2, 830 [55%]) had evidence of AFO on spirometry. Of patients with a clinical diagnosis of COPD, 3, 209 (62.3%) were also treated with inhaled medications (Fig 1). Table 1 shows the characteristics of patients treated for COPD with and without AFO by
Discussion
We found that a little over one-half of patients who receive a clinical diagnosis of and were treated for COPD have AFO on spirometry, raising the concern that patients are being inappropriately treated for a condition that they do not have. The current study is consistent with previous studies that suggested providers diagnose COPD and make treatment decisions based on history and clinical examination despite guideline recommendations to diagnose COPD with spirometry.5, 6 Among veterans being
Conclusions
Empirical diagnosis of COPD often is inaccurate, yet many patients who lack AFO are treated with inhaled medications. Patients with more comorbid illnesses are at greater risk for empirical diagnosis and treatment of COPD in the absence of AFO. Accurate diagnosis and treatment of COPD are important to improve quality of care, patient-centered outcomes, and resource utilization. Implementation of performance-based measures for COPD may improve the accuracy of diagnosis and treatment of patients
Acknowledgments
Author contributions: B. F. C. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. B. F. C. contributed to the study design, data analysis and interpretation, and preparation, review, and approval of the manuscript; L. C. F. and D. H. A. contributed to the design and conduct of the study, data collection, management, analysis, and interpretation, and preparation, review, and approval of the manuscript; and
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2017, CMAJCitation Excerpt :The 2001, 2003, 2005 and 2007/8 national, population-based Canadian Community Health Surveys provided additional information, including smoking history, for the patients who participated in the survey. Physician-diagnosed COPD is an imperfect measure of COPD — likely, at least in part, because not all patients receive pulmonary function testing.8,18 All patients aged 43 and older with physician-diagnosed 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
FUNDING/SUPPORT: This study was funded by an American Lung Association Career Investigator Award [CI-51755N]. Drs Collins and Rinne are supported by National Institutes of Health (NIH) [Training Grant T32 HL007287]. Dr Feemster is funded by an NIH National Heart, Lung, and Blood Institute K23 Mentored Career Development Award [K23 HL111116] and by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D). Dr Au is supported by the VA HSR&D.