Spirometry Use in Clinical Practice Following Diagnosis of COPD

doi:10.1378/chest.129.6.1509

Chest

Volume 129, Issue 6, June 2006, Pages 1509-1515

https://doi.org/10.1378/chest.129.6.1509 Get rights and content

Background

Little is known about current use of pulmonary function testing in clinical practice. This study evaluated spirometry use in persons with COPD receiving care from the Veterans Health Administration health-care system.

Methods

Administrative data were used to identify a cohort of patients who were ≥ 40 years of age with recently diagnosed COPD. Spirometry was identified using administrative data. Spirometry use was characterized over a 12-month period, and the use of spirometry around acute exacerbations and surgical procedures was examined.

Results

A total of 197,878 patients met the inclusion criteria in 1999. The average age was 67.5 years (SD, 10.0), and 98.2% of patients were male. A total of 66,744 patients (33.7%) underwent spirometry. The use of spirometry for newly diagnosed COPD patients decreased with age and was 3.3 times higher for those visiting pulmonologists.

Conclusions

This study suggests that spirometry is inconsistently used in the diagnosis of COPD or the care of patients with COPD. This inconsistent pattern of use is seen even with the endorsement of spirometry use for patients with COPD by two national guidelines; however, the data predate the most recent version of the guidelines. It is unclear whether it is lack of physician knowledge of, attitudes about, or belief in the utility of spirometry that underlie the current patterns of physician use of this clinical tool.

Section snippets

Materials and Methods

This project was approved by the institutional review board of the Hines Veterans Affairs Hospital. Using a retrospective cohort design, VHA administrative data were used to identify patients with a diagnosis of COPD. Patients with at least two visits with diagnoses of COPD (International Classification of Diseases, ninth revision [ICD-9] codes 491.x, 492.x, and 496) between October 1, 1998, and September 30, 1999, were eligible to be included in the analysis. To be included, patients must have

Results

A total of 197,878 patients with newly diagnosed COPD were included in the analysis. Of these patients, 98% were male, and 66,744 (33.7%) had undergone at least one spirometry session during the 12-month period (Table 1). Those patients in the spirometry group were slightly younger (mean age, 66.6 years) than those who had not undergone spirometry (mean age, 68.0 years; p < 0.001).

In the adjusted analysis, as expected, a pulmonary clinic visit was the factor that had the highest association

Discussion

The objective of this study was to examine spirometry use in routine clinical practice in patients with a new diagnosis of COPD. Overall, the presence of spirometry in patients with a new diagnosis of COPD was low, with only 33.7% of patients having spirometry performed during the analysis period. The patients who were more likely to undergo spirometry were those who had been to a pulmonary clinic and those in younger age groups. The use of spirometry to assess lung function after an acute

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)

This project was funded by Veterans Affairs Health Services Research and Development Investigator Initiated Research grant 03–307.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US Government.

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Chest

Original ResearchSpirometry Use in Clinical Practice Following Diagnosis of COPD

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Chest

Chest

Respir Med

Clin Chest Med

Chest

Chest

Chest

Respir Med

Clin Chest Med

Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

Eur Respir J

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary

Am J Respir Crit Care Med

National Committee for Quality Assurance

HEDIS 2006: technical specifications

Original Research
Spirometry Use in Clinical Practice Following Diagnosis of COPD