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Open Access Highly Accessed Research article

Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

Valentin Prieto Centurion1, Frank Huang2, Edward T Naureckas2, Carlos A Camargo Jr3, Jeffrey Charbeneau1, Min J Joo1, Valerie G Press2 and Jerry A Krishnan14*

Author Affiliations

1 University of Illinios at Chicago, Chicago, IL, USA

2 University of Chicago Medicine, Chicago, IL, USA

3 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

4 University of Illinois Hospital & Health Sciences System, Medical Center Administration Building, 914 S. Wood Street, MC 973, Chicago, IL, 60612, USA

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BMC Pulmonary Medicine 2012, 12:73  doi:10.1186/1471-2466-12-73

Published: 7 December 2012

Abstract

Background

Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation.

Methods

Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.

Results

There was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007).

Conclusions

Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.

Keywords:
Asthma; COPD; Exacerbation; Hospitalization; Spirometry; Quality improvement