Spyridon Fortis1, Edward O Corazalla2, David R Jacobs3, Hyun J Kim4. 1. Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. spyridon-fortis@uiowa.edu. 2. Pulmonary Function Test Laboratory, University of Minnesota Medical Center, Minneapolis, Minnesota. 3. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota. 4. Pulmonary Function Test Laboratory, University of Minnesota Medical Center, Minneapolis, Minnesota. Division of Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Abstract
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.
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.
Authors: Andrei Schwartz; Nicholas Arnold; Becky Skinner; Jacob Simmering; Michael Eberlein; Alejandro P Comellas; Spyridon Fortis Journal: Respir Care Date: 2020-09-01 Impact factor: 2.258
Authors: Emily S Wan; Pallavi Balte; Joseph E Schwartz; Surya P Bhatt; Patricia A Cassano; David Couper; Martha L Daviglus; Mark T Dransfield; Sina A Gharib; David R Jacobs; Ravi Kalhan; Stephanie J London; Ana Navas-Acien; George T O'Connor; Jason L Sanders; Benjamin M Smith; Wendy White; Sachin Yende; Elizabeth C Oelsner Journal: JAMA Date: 2021-12-14 Impact factor: 157.335
Authors: Spyridon Fortis; Alejandro Comellas; Victor Kim; Richard Casaburi; John E Hokanson; James D Crapo; Edwin K Silverman; Emily S Wan Journal: Sci Rep Date: 2020-03-20 Impact factor: 4.379