Overdiagnosis of COPD in hospitalized patients
Authors Spero K, Bayasi G, Beaudry L, Barber KR, Khorfan F
Received 19 April 2017
Accepted for publication 19 June 2017
Published 11 August 2017 Volume 2017:12 Pages 2417—2423
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Kerry Spero,1 Ghiath Bayasi,2 Linda Beaudry,3 Kimberly R Barber,4 Fahim Khorfan2
1Department of Medical Education, Genesys Regional Medical Center, Grand Blanc, 2Department of Pulmonary and Critical Care Medicine, Michigan State University, East Lansing, 3Department of Respiratory Therapy, 4Department of Research, Genesys Regional Medical Center, Grand Blanc, MI, USA
Background: The diagnosis of chronic obstructive pulmonary disease (COPD) is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are nonspecific and attributable to a variety of diseases. Confirmatory testing to verify the airflow obstruction is available but rarely used, which may result in substantial misdiagnoses of COPD. The aim of this study is to evaluate the use of confirmatory testing and assess the accuracy of the diagnosis.
Methods: From January 2011 through December 2013, 6,018 patients with COPD as a principal or leading diagnosis were admitted at a community teaching hospital. Of those, only 504 (8.4%) patients had spirometry performed during hospitalization. The studies were reviewed by two board-certified pulmonologists to verify presence of persistent airflow obstruction. Charts of these patients were then examined to determine if the spirometry results had changed the diagnosis or the treatment plan for these patients.
Results: Spirometry confirmed the diagnosis of COPD in 270 patients (69.2%) treated as COPD during their hospitalization. Restrictive lung disease was found to be present in 104 patients (26.6%) and normal in 16 patients (4.2%). Factors predictive of airflow obstruction included smoking status and higher pack-year history. Negative predictive factors included higher body mass index (BMI) and other medical comorbidities. These patients were significantly more likely to be misdiagnosed and mistreated as COPD.
Conclusion: Up to a third of patients diagnosed and treated as COPD in the hospital may be inaccurately diagnosed as COPD based on confirmatory spirometry testing. Factors contributing to the inaccuracy of diagnosis include less smoking history, high BMI, and associated comorbidities.
Keywords: COPD, spirometry, overdiagnosis, misdiagnosis