COPD

Gaps in the provision of spirometry to confirm COPD are missed opportunities


Spirometry results are often either missing from charts of inpatients with a COPD diagnosis or inconsistent with the diagnosis, an Australian study has found.

The results suggest spirometry for diagnosis of COPD is underutilised – representing a significant deviation in practice from clinical guidelines.

The retrospective study of 1,469 inpatients with a clinical diagnosis of COPD found 43.6% of patients had no available spirometry results on the EMR or laboratory database at hospital discharge.

Among those with spirometry available, only 36.6% had spirometry results consistent with a clinical diagnosis of COPD.

“Where COPD was the primary diagnosis, 43.8% of patients had spirometry consistent with the clinical diagnosis of COPD. Whereas those with COPD as a secondary diagnosis, n=308 (32.8%) had spirometry consistent with a clinical diagnosis of COPD.”

The study, published in the Internal Medicine Journal, said prescribing patterns were similar irrespective of whether spirometry had previously been performed and remained unchanged whether spirometry was consistent or inconsistent with a diagnosis of COPD.

Almost half of patients (49.6%) prescribed an ICS containing regimen either had no spirometry or had spirometry inconsistent with a clinical diagnosis of COPD.”

“This single centre study has identified apparent underutilisation of spirometry among people hospitalised with a clinical diagnosis of COPD,” the investigators said.

“Prescribing patterns associated with these admissions demonstrate the potential pitfalls of underutilisation, with frequent prescription of inhaled medicines for COPD, including frequent prescription of ICS, regardless of spirometry results.”

The investigators, from the Department of Respiratory Medicine at Northern Health in Victoria, said failing to perform spirometry amounted to missed opportunities to secure a diagnosis and optimise treatment.

“For example, smokers with a spirometric diagnosis of COPD are more likely to quit and remain abstinent from smoking when compared to those with normal spirometry.”

“Confirmation of a diagnosis using an objective test may enhance an individual’s awareness and understanding of their clinical condition and influence their decision making.”

They said it would also provide clinicians with greater confidence in their treatment approaches during subsequent hospital admissions.

“For individual patients, misdiagnosis has the potential to cause harm, including readmission or delays in the management of other serious disorders that mimic COPD.”

They noted that, given 1 in 5 patients had spirometry results inconsistent with the clinical diagnosis of COPD, interpreting spirometry results and ensuring they influence clinical management may also require attention.

 

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