Spirometry remains underutilized for the diagnosis of chronic obstructive pulmonary disease (COPD) in the primary care setting and when it is used it is commonly associated with misdiagnosis, according to findings from a study to be reported here at CHEST 2016, the the annual meeting of the American College of Chest Physicians.
When researchers from Corpus Christi Medical Center in Texas conducted a review of charts from 65 patients with a diagnosis of COPD, they found that roughly a third had undergone spirometry or had spirometry results available.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends spirometry to establish such a COPD diagnosis in patients with a history of chronic cough, sputum production, difficulty breathing, or exposures to risk factors, such as smoking.
Almost a third (31.6%) of patients with spirometry results in the chart review study were found to be misclassified because the spirometric measurements did not confirm the disease.
The study results show little improvement in the utilization of spirometry in primary care practice since the GOLD guidelines were introduced more than a decade ago, said co-author Stephen Eikermann, DO.
"The rate of spirometry utilization that we saw is similar to what was being reported a decade ago in primary care, despite the GOLD guidelines," Eikermann told MedPage Today. "COPD is one of the most common conditions treated by primary care physicians, and our findings suggest that there is a disconnect with regard to diagnosing this disease."
Eikermann said the continued low utilization of spirometry in the general practice setting may be due to a lack of education among general practitioners about its importance, adding that some general practitioners may also feel that the GOLD guidelines have become too complex.
It is estimated that as many as 50% of the more than 12 million people living with COPD in the United States have not been diagnosed with the disease, and that the economic burden associated with treating the disease will reach close to $50 billion by 2020.
"We have two problems in COPD screening," David Schulman, MD, MPH, of Emory University in Atlanta told MedPage Today. "One is that we have patients who probably should be screened for COPD who aren't being screened. Pretty much anybody over the age of 45 with a history of smoking and any symptoms should be screened, and spirometry is cheap and available.
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"The other thing is that there are people out there being labeled with COPD who may not have it. That's because clinicians often assume that patients with these characteristics have COPD without [there being] a formal diagnosis."
