Diagnosis Of COPD In Patients Research Articles

The clinical implications of tests confirming COPD in subjects hospitalized with exacerbations

ABSTRACTBackground: The diagnosis of COPD in patients hospitalized for AECOPD can be confirmed by spirometry showing obstruction or radiographs showing emphysema. The evidence for COPD is sometimes absent or contradicts this diagnosis. The inaccurate attribution of the exacerbation to COPD can lead to suboptimal care and worse outcome.Objectives: We determined if the presence of tests that confirm the diagnosis of COPD has any implications on the course of the hospitalization and readmission rate.Methods: We selected subjects hospitalized between 2012 and 2014 for AECOPD. We divided them into four hierarchical, mutually exclusive groups based on the presence of tests that confirm the diagnosis of COPD: spirometry (COPDSPIRO), radiology (COPDRAD), clinical diagnosis (COPDCLIN), and no COPD by spirometry (NotCOPD). We compared the presentation, hospital course, outcome, and readmission rate between the four groups.Results: We identified 974 subjects: COPDSPIRO 22%, COPDRAD 24%, COPDCLIN 46% and 7% NotCOPD. The vital signs, use of respiratory support, admission to the MICU, and length of stay were similar between the groups. The age, gender, BMI, presence of comorbidities, and readmission rate were different between the groups. The NotCOPD group had the highest BMI (38 kg/m2), comorbidities, and 30-day all-cause readmission (17%). Logistic regression showed that serum creatinine and presence of any comorbidity were the independent predictors of 30-day all-cause readmission.Conclusion: COPD was confirmed by spirometry or radiographs in half of the subjects hospitalized for AECOPD. The presence of confirmation did not influence the hospital course. The presence of confirmation was associated with different readmission rate, but was accounted for by the presence of comorbidities.

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results. To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry. Retrospective cohort study. A cohort that met the following criteria was identified: ≥35years of age; ≥ 2 primary care visits in internal medicine clinic in 2007; at least one respiratory or smoking cessation medication, or diagnosis of COPD or shortness of breath or dyspnea in 2007. Medical records of all primary care physician visits prior to the time of inclusion in 2007 were reviewed. Data on patient demographics, co-morbidities, respiratory medication use, presence of symptoms, history of tobacco use, and pulmonary function tests were extracted. A total 1052 patients were identified. Dyspnea on exertion (Adjusted odds ratio (AOR) 1.52 [95% CI 1.06-2.18]) and chronic cough (AOR 1.71 [1.07-2.72]) were the only chronic symptoms associated with use of spirometry. Current (AOR 1.54 [0.99-2.40]) or past smoking (AOR 1.09 [0.72-1.65]) status were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD. Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.

Relationship Between Gastroesophageal Reflux Disease and COPD in UK Primary Care

Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care. We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis. During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease. Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.