RT Journal Article
SR Electronic
T1 Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.04647
DO 10.4187/respcare.04647
A1 Spyridon Fortis
A1 Edward O Corazalla
A1 David R Jacobs, Jr
A1 Hyun J Kim
YR 2016
UL http://rc.rcjournal.com/content/early/2016/05/10/respcare.04647.abstract
AB BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.