Bridget F Collins1, David Ramenofsky2, David H Au3, Jun Ma4, Jane E Uman3, Laura C Feemster3. 1. Health Services Research and Development, Department of Veterans Affairs, Seattle, WA. Electronic address: bfc3@uw.edu. 2. Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA. 3. Health Services Research and Development, Department of Veterans Affairs, Seattle, WA. 4. Department of Health Services Research, Palo Alto Medical Foundation Research Institute, and Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA.
Abstract
BACKGROUND: Most patients with a clinical diagnosis of COPD have not had spirometry to confirm airflow obstruction (AFO). Overweight and obese patients report more dyspnea than normal weight patients, which may be falsely attributed to AFO. We sought to determine whether overweight and obese patients who received a clinical diagnosis of COPD were more likely to receive a misdiagnosis (ie, lack of AFO on spirometry) and be subsequently treated with inhaled medications. METHODS: The cohort comprised US veterans with COPD (International Classification of Diseases, 9th Revision, code; inhaled medication use; or both) and spirometry measurements from one of three Pacific Northwest Veterans Administration Medical Centers. The measured exposures were overweight and obesity (defined by BMI categories). Outcomes were (1) AFO on spirometry and (2) escalation or deescalation of inhaled therapies from 3 months before spirometry to 9 to 12 months after spirometry. We used multivariable logistic regression with calculation of adjusted proportions for all analyses. RESULTS: Fifty-two percent of 5,493 veterans who had received a clinical diagnosis of COPD had AFO. The adjusted proportion of patients with AFO decreased as BMI increased (P < .01 for trend). Among patients without AFO, those who were overweight and obese were less likely to remain off medications or to have therapy deescalated (adjusted proportions: normal weight, 0.69 [95% CI, 0.64-0.73]; overweight, 0.62 [95% CI, 0.58-0.65; P = .014]; obese, 0.60 [95% CI, 0.57-0.63; P = .001]). CONCLUSIONS: Overweight and obese patients are more likely to be given a misdiagnosis of COPD and not have their inhaled medications deescalated after spirometry demonstrated no AFO. Providers may be missing potential opportunities to recognize and treat other causes of dyspnea in these patients.
BACKGROUND: Most patients with a clinical diagnosis of COPD have not had spirometry to confirm airflow obstruction (AFO). Overweight and obesepatients report more dyspnea than normal weight patients, which may be falsely attributed to AFO. We sought to determine whether overweight and obesepatients who received a clinical diagnosis of COPD were more likely to receive a misdiagnosis (ie, lack of AFO on spirometry) and be subsequently treated with inhaled medications. METHODS: The cohort comprised US veterans with COPD (International Classification of Diseases, 9th Revision, code; inhaled medication use; or both) and spirometry measurements from one of three Pacific Northwest Veterans Administration Medical Centers. The measured exposures were overweight and obesity (defined by BMI categories). Outcomes were (1) AFO on spirometry and (2) escalation or deescalation of inhaled therapies from 3 months before spirometry to 9 to 12 months after spirometry. We used multivariable logistic regression with calculation of adjusted proportions for all analyses. RESULTS: Fifty-two percent of 5,493 veterans who had received a clinical diagnosis of COPD had AFO. The adjusted proportion of patients with AFO decreased as BMI increased (P < .01 for trend). Among patients without AFO, those who were overweight and obese were less likely to remain off medications or to have therapy deescalated (adjusted proportions: normal weight, 0.69 [95% CI, 0.64-0.73]; overweight, 0.62 [95% CI, 0.58-0.65; P = .014]; obese, 0.60 [95% CI, 0.57-0.63; P = .001]). CONCLUSIONS: Overweight and obesepatients are more likely to be given a misdiagnosis of COPD and not have their inhaled medications deescalated after spirometry demonstrated no AFO. Providers may be missing potential opportunities to recognize and treat other causes of dyspnea in these patients.
Authors: Vipul V Jain; D Richard Allison; Sherry Andrews; Janil Mejia; Paul K Mills; Michael W Peterson Journal: Lung Date: 2015-04-29 Impact factor: 2.584
Authors: Krysttel Stryczek; Colby Lea; Chris Gillespie; George Sayre; Scott Wanner; Seppo T Rinne; Renda Soylemez Wiener; Laura Feemster; Edmunds Udris; David H Au; Christian D Helfrich Journal: J Gen Intern Med Date: 2019-08-08 Impact factor: 5.128
Authors: Matthew F Griffith; Laura C Feemster; Steven B Zeliadt; Lucas M Donovan; Laura J Spece; Edmunds M Udris; David H Au Journal: J Gen Intern Med Date: 2019-11-11 Impact factor: 5.128
Authors: Valentin Prieto-Centurion; Andrew J Rolle; David H Au; Shannon S Carson; Ashley G Henderson; Todd A Lee; Peter K Lindenauer; Mary A McBurnie; Richard A Mularski; Edward T Naureckas; William M Vollmer; Binoy J Joese; Jerry A Krishnan Journal: Am J Respir Crit Care Med Date: 2014-11-01 Impact factor: 21.405