Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

Valentin Prieto Centurion,Min J Joo,Frank Huang,Jeffrey Charbeneau,Jerry A Krishnan,Valerie G Press,Edward T Naureckas,Carlos A Camargo Jr

doi:10.1186/1471-2466-12-73

Abstract

BackgroundObjective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation.MethodsMulti-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.ResultsThere was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007).ConclusionsAdequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.

Highlights

Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or chronic obstructive pulmonary disease (COPD)
While confirmatory spirometry is recommended by the European Respiratory Society/American Thoracic Society guidelines to establish a diagnosis of asthma or COPD, is not routinely performed during hospitalizations for exacerbations, due to concerns about its feasibility and a lack of data supporting its utility
Data about the prevalence of patients with a physician diagnosis of an asthma exacerbation but in whom spirometry fails to confirm obstructive lung disease are lacking. To address these gaps in knowledge, we conducted a multi-center study in adults hospitalized with a physician diagnosis of asthma or COPD exacerbation to: a) evaluate the quality of spirometry tracings; and b) assess the utility of confirmatory spirometry for the presence of obstructive lung disease in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation

Summary

Methods

Patient population As part of several hospital-based studies [14,15], we screened admission logs to identify adults admitted for asthma or COPD exacerbations at four universityaffiliated medical centers (The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, The University of Chicago Medical Center, and Mercy Hospital and Medical Center). Since the participants received standard care while in the hospital, a physician diagnosis of asthma or COPD exacerbation was sufficient. Written informed consent was obtained from patients who met all inclusion criteria (age ≥18 years, admitted to the general ward, and physician diagnosis of asthma or COPD exacerbation). To be considered of adequate quality, spirometry tracings had to satisfy the criteria for both acceptability and reproducibility. A spirometry test had to fulfill the criteria for acceptability and reproducibility by both raters to be considered adequate quality. Analyses were performed using STATA software package, release 10.0 (Stata Corp Inc, College Station, Texas)

Results

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Discussion

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