Underuse of Spirometry Testing amongst Chronic Obstructive Pulmonary Disease Patients
Jamia Saunders¹, MD, MS, Suna Chung¹, MPH, Hina Malik1, MPH, Samuel W. Kim¹, BS, Mohammad Naqibuddin¹, MBBS, MPH, Hanan Aboumatar¹²³4, MD, MPH
¹Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine
²Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine
³Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
4Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University
Introduction
Purpose
The purpose of the study is to assess the use of prior
spirometry testing amongst patients who are hospitalized for
treatment of COPD.
Materials and Methods
• We conducted a cross-sectional study using baseline data
from an ongoing clinical trial (The BREATHE Study, Clinical
trials.gov # NCT02036294).
• Two-hundred and forty patients who were hospitalized for
treatment of COPD at an urban academic center were
enrolled.
• Additional study criteria required patients to be older than 40
years and have more than 10 pack-years smoking history.
• Patients reported their level of breathlessness using the
modified Medical Research Council (mMRC) Dyspnea Scale at
baseline. 5, 6
• Electronic medical records were searched for spirometry data
within the past 10 years.
• Data analysis was performed using STATA 14.
• The mean age of the patient participants was 64.3 ± 9.8 years, and 148 patients (61.7%) were
female.
• Most of the patients identified as Caucasian (83%) and eighty four percent had an annual
income of $40,000 or less.
• Forty-one percent of the patient participants required continuous oxygen treatment and 38.3%
were current smokers.
• Among the 240 patient participants, one hundred sixty five patients (68%) have previously
recorded spirometry test results within the past 10 years.
• 88% of the patients had a self-reported mMRC grade of 3 or 4.
• Among patients with mMRC Grades 3 and 4, only 69.5% of the patients had a previous
spirometry test result in their electronic medical records.
mMRC Grade (description)
Total (%)
0 (I only get breathless with strenuous exercise.)
6 (2.5%)
1 (I get short of breath when hurrying on level ground or walking up a slight
hill.)
2 (On level ground, I walk slower than people of the same age because of
breathlessness, or have to stop for breath when walking at my own pace.)
6 (2.5%)
3 (I stop for breath after walking about 100 yards or after a few minutes on
level ground.)
4 (I am too breathless to leave the house or I am breathless when dressing.)
18 (7.5%)
76 (31.7%)
134 (55.8%)
Table 1. Patient self-report of dyspnea as measured by mMRC grade (n=240).
100%
% of patients with spirometry testing
• Chronic Obstructive Pulmonary Disease (COPD) is the third
leading cause of death in the US, and a prevalent condition
around the world that results in high mortality, morbidity, and
functional limitations that impact the quality of life.1
• About 12.7 million US adults are diagnosed with COPD and 24
million adults are estimated to have undiagnosed COPD.2
• According to the recommendations of the Global Initiative for
Chronic Obstructive Lung Disease (GOLD), spirometry should
be performed to establish the diagnosis of COPD in any
patient who has a history of chronic cough, sputum
production, difficulty breathing, or exposure to risk factors. 3
• Treatment guidelines for COPD differ based on disease
severity classifications, and those are determined by
spirometry test results (an objective measure of airflow
restriction), along with patient symptoms and history of prior
exacerbations. 4
Conclusions
Results
83%
90%
80%
67%
70%
60%
75%
61%
33%
30%
20%
10%
0%
0
References
1Qureshi,
H., Sharafkhaneh, A., & Hanania, N. A. (2014). Chronic
obstructive pulmonary disease exacerbations: latest evidence and
clinical implications. Therapeutic Advances in Chronic Disease, 5(5),
212-227.
2American Lung Association, Epidemiology and Statistics Unit,
Research and Health Education.
3Global Initiative for Chronic Obstructive Lung Disease. (2017).
Retrieved February 10, 2017, from http://goldcopd.org/
Division. Trends in COPD: Morbidity and Mortality. March 2013.
4 Global Initiative for Chronic Obstructive Lung Disease: Global
Strategy for the Diagnosis, Management, and Prevention of COPD,
2017.
5 Medical Research Council on the Etiology of Chronic Bronchitis.
Standardized questionnaire on respiratory symptoms. Br Med J 1960;
2:1665.
6 Cotes JE. Medical Research Council Questionnaire on respiratory
symptoms. Correspondence. Lancet 1987;2: 1028
Acknowledgements
Conclusion
We acknowledge BREATHE Study Research Team Members, Patient Family
50%
40%
• About a third of patients who are hospitalized for
treatment of COPD have not had spirometry testing in the
past 10 years.
• This represents a missed opportunity for following
evidence-based guidelines for COPD diagnosis and
treatment.
• Increased use of spirometry testing would lead to more
accurate diagnoses and may improve physicians' treatment
recommendations.
1
2
3
mMRC Grade
Figure 1. Spirometry use by mMRC grade category (n=240).
4
Partners, and COPD patients.
This work was funded through a Patient-Centered Outcomes Research
Institute (PCORI) Improving Healthcare Systems Award (IH 1304 – 7118).
PCORI was not involved in the study design; data collection, analysis and
interpretation; or in the writing of the presentation.