Journal article
Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction
Respiratory care, Vol.61(9), pp.1192-1200
09/2016
DOI: 10.4187/respcare.04647
PMID: 27165420
Abstract
Health-care providers often diagnose and empirically treat COPD without a confirmative pulmonary function test (PFT) or even despite a PFT that is not diagnostic of obstructive lung disease. We hypothesized that a portion of patients continue to carry a persistent empiric COPD diagnosis and receive treatment with bronchodilators and inhaled steroids after a PFT shows no obstruction.
We retrospectively reviewed single PFT sessions with both spirometry and plethysmography in 1,805 subjects. We included subjects who had a normal PFT or a restrictive ventilatory defect. Persistent empiric COPD diagnosis and treatment were defined when subjects with normal PFTs or a restrictive ventilatory defect continued to carry a health-care provider COPD diagnosis or receive treatment with bronchodilators and/or inhaled glucocorticoids, respectively, after a PFT showed no obstruction.
One quarter of subjects with FEV1/FVC ≥ lower limit of the normal range had nonspecific PFT abnormalities. We included 473 subjects with normal PFTs and 382 with a restrictive ventilatory defect (n = 855). Persistent empiric COPD diagnosis (60 of 855, 7% prevalence) was associated with current (odds ratio [OR] = 44.7, P < .001) and former smoking (OR = 17.3, P < .001) and older age (OR = 1.03/y, P = .005). Persistent empiric treatment (208 of 855, 24%) was associated with empiric COPD diagnosis (OR = 24.6, P < .001), female sex (OR = 1.75, P = .002), current (OR = 2.04, P = 0.040) and former smoking (OR = 1.53, P = 0.029), interstitial lung disease (OR = 2.09, P = .001), other respiratory diagnosis (OR = 3.17, P < .001), and obstructive sleep apnea (OR = 1.79, P = .006).
Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.
Details
- Title: Subtitle
- Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction
- Creators
- Spyridon Fortis - Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. spyridon-fortis@uiowa.eduEdward O Corazalla - Pulmonary Function Test Laboratory, University of Minnesota Medical Center, Minneapolis, MinnesotaDavid R Jacobs Jr - Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MinnesotaHyun J Kim - Pulmonary Function Test Laboratory, University of Minnesota Medical Center, Minneapolis, Minnesota. Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Resource Type
- Journal article
- Publication Details
- Respiratory care, Vol.61(9), pp.1192-1200
- DOI
- 10.4187/respcare.04647
- PMID
- 27165420
- ISSN
- 0020-1324
- eISSN
- 1943-3654
- Language
- English
- Date published
- 09/2016
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094216202771
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