August 2007 Press Release
STUDY SAYS COPD TESTING IS NOT MEASURING UP
Spirometry Is Underutilized in Patients, Overreported by Doctors
(NORTHBROOK, IL, August 13, 2007) —Spirometry testing is a widely accepted and
encouraged diagnostic method for chronic obstructive pulmonary disease (COPD), but new research
shows that it is not used nearly enough. The study appears in the August issue of CHEST, the peerreviewed
journal of the American College of Chest Physicians (ACCP) and reports that only one-third
of patients with a COPD diagnosis ever received spirometry testing.
"Without proper testing, both underdiagnosis and misdiagnosis may occur, which can lead to
improper therapies being prescribed," said lead author MeiLan Han, MD, MS, University of Michigan,
Division of Pulmonary and Critical Care Medicine. "This study shows that we have a lot of work ahead
of us in terms of raising awareness among both patients and physicians."
Along with colleagues from Johns Hopkins University, the University of Washington, and the
National Committee for Quality Assurance, Dr. Han identified patients with newly diagnosed COPD
by data collected from five health plans. The study examined patients aged 40 years and older, and
determined if patients with a new diagnosis of COPD had received spirometry in the preceeding 720
days. Of the 5,039 eligible patients identified, only 32% were found to have received spirometry
testing. Furthermore, only half of those patients received follow-up bronchodilator testing to confirm
their diagnosis.
"In order to distinguish COPD from other diseases, such as asthma, spirometry must be
measured both before and after administration of medication that dilates the airways," Dr. Han
explained. "As such, if COPD is suspected, initial spirometric testing should include bronchodilator
testing too, in order for that patient to receive a truly diagnostic test."
In addition, the study notes that these numbers contradict previous findings in which over 70%
of physicians reported using spirometry for establishing a COPD diagnosis. Given the contrast, Dr.
Han suggests a possible difference between what physicians say and what they actually do. Also of
particular concern was that, according to this study, spirometry testing in those patients who were 75
years and older was performed less frequently, with only 28% of patients in this population receiving
spirometry. Researchers point to the issue of ageism and question whether or not a patient’s age
influences a physician’s decision to order diagnostic testing.
"The bad news is that we have significant room for improvement. The good news is that we
have to know a problem exists before we can fix it, and now we know," said Dr. Han. Other good news
is that women and men fared virtually the same when it came to spirometry testing, despite previous
reports suggesting women were tested less often.
"COPD is currently the fourth leading cause of death in the United States, and the economic
burden of this disease is measured in the billions of dollars but, despite this, it is so often
underdiagnosed or misclassified," said Dr. Han. "Prior to this study, I did not truly appreciate the
magnitude of spirometry underutilization, but my hope is that this will lead to more correct diagnoses
and better care of patients."
"Spirometry testing is an inexpensive, quick, and painless procedure, which is necessary to
confirm a COPD diagnosis," said Mark J. Rosen, MD, FCCP, President of the American College of
Chest Physicians. "In order to make a shift in the underutilization of spirometry, physicians need to use
all of the resources available to them, and patients need to actively inquire about their care."
Dr. Han suggests that current and former smokers aged 45 years and older, as well as any
patient who experiences cough, shortness of breath with exertion, or wheezing, ask their doctor about
having a spirometry test performed.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at
www.chestjournal.org. The journal’s Web site also provides public access to thousands of archived
studies, dating back to 1946—a newly added feature that is free of charge. The ACCP represents
16,600 members who provide clinical respiratory care, sleep medicine, critical care, and cardiothoracic
patient care in the United States and throughout the world. The ACCP’s mission is to promote the
prevention and treatment of diseases of the chest through leadership, education, research, and
communication. For more information about the ACCP, please visit the ACCP Web site at
www.chestnet.org.
Contact:
Jennifer Stawarz, (847) 498-8306
Deana Busche, (847) 498-8387
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