Spirometry use in clinical practice following diagnosis of COPD

Little is known about current use of pulmonary function testing in clinical practice. This study evaluated spirometry use in persons with COPD receiving care from the Veterans Health Administration health-care system.

Administrative data were used to identify a cohort of patients who were >/= 40 years of age with recently diagnosed COPD. Spirometry was identified using administrative data. Spirometry use was characterized over a 12-month period, and the use of spirometry around acute exacerbations and surgical procedures was examined.

A total of 197,878 patients met the inclusion criteria in 1999. The average age was 67.5 years (SD, 10.0), and 98.2% of patients were male. A total of 66,744 patients (33.7%) underwent spirometry. The use of spirometry for newly diagnosed COPD patients decreased with age and was 3.3 times higher for those visiting pulmonologists.

This study suggests that spirometry is inconsistently used in the diagnosis of COPD or the care of patients with COPD. This inconsistent pattern of use is seen even with the endorsement of spirometry use for patients with COPD by two national guidelines; however, the data predate the most recent version of the guidelines. It is unclear whether it is lack of physician knowledge of, attitudes about, or belief in the utility of spirometry that underlie the current patterns of physician use of this clinical tool.