COPD Is Being Diagnosed Too Hastily

Family physicians frequently diagnose chronic obstructive pulmonary disease (COPD) according to patient's symptoms and smoking history. In order to obtain a definitive diagnosis, the patient should also undergo a spirometry (lung function) test.

Approximately 60% of patients newly diagnosed with COPD did not receive spirometry testing, reported Todd A. Lee, PharmD., Ph.D., of the Hines Veterans Affairs Hospital (Hines, IL, USA), and colleagues in the July 2006 issue of the journal Chest. "As a result patients who do not have COPD may be receiving unnecessary chronic therapy,” said Dr. Lee.

The investigators examined the medical records of nearly 200,000 patients in the Veterans Health Administration (VHA) health-care system diagnosed with COPD from October 1998 to September 1999. Most of the patients (98%) were male and the average age was 67.5. More than 95% had been diagnosed by a family physician during an out-patient visit. Only 67,000 of the patients (33.3%) underwent spirometry.

Increasing age was associated with decreasing likelihood of receiving the lung function test. "Providers may be more reluctant to use spirometry in older patients,” said Dr Lee. However, there is no indication in the literature that age should exclude patients from undergoing the test.

Among patients who suffered an acute exacerbation of COPD, only about 21% underwent spirometry afterward. Current guidelines recommend that the test be given four to six weeks after an exacerbation. Patients referred to pulmonary clinics or patients about to have surgery were more likely to undergo spirometry testing.

The authors of the report said that guidelines from the American Thoracic Society, the European Respiratory Society, and the Global Initiative for Chronic Obstructive Lung Disease all indicate that spirometry is necessary to diagnose COPD.



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Hines Veterans Affairs Hospital