Key tests for COPD vastly underutilized

Spirometry testing is a widely accepted and encouraged diagnostic method for chronic obstructive pulmonary disease (COPD), but research shows that it is not used nearly enough. "Without proper testing, both underdiagnosis and misdiagnosis may occur, which can lead to improper therapies being prescribed," cautions MeiLan Han of the University of Michigan's Division of Pulmonary and Critical Care Medicine, Ann Arbor.

"This study shows that we have a lot of work ahead of us in terms of raising awareness among both patients and physicians.

"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. 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 contradicts previous findings in which more than 70% of physicians reported using spirometry for establishing a COPD diagnosis. Given the contrast, Han suggests a possible difference between what physicians say and what they actually do. Also of particular concern is 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 it. 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.

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"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," indicates Han. "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."

"Spirometry testing is an inexpensive, quick, and painless procedure, which is necessary to confirm a COPD diagnosis," notes Mark J. Rosen, president of the American College of Chest Physicians, Northbrook, Ill. "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."

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