Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction

Area of Science:

• Pulmonary Medicine
• Diagnostic Accuracy
• Respiratory Health

Background:

• Healthcare providers frequently diagnose and treat Chronic Obstructive Pulmonary Disease (COPD) empirically.
• This often occurs without definitive Pulmonary Function Tests (PFTs) or despite PFT results not indicating obstruction.
• This practice may lead to misdiagnosis and inappropriate treatment.

Purpose of the Study:

• To investigate the prevalence of persistent empiric COPD diagnosis and treatment in patients with normal or restrictive PFTs.
• To identify factors associated with continued empiric diagnosis and treatment.
• To assess the impact of PFT results on ongoing COPD management.

Main Methods:

• Retrospective review of 1,805 PFT sessions including spirometry and plethysmography.
• Inclusion criteria: subjects with normal PFTs or restrictive ventilatory defects.
• Definition of persistent empiric diagnosis/treatment: continued COPD diagnosis or treatment post-PFT showing no obstruction.

Main Results:

• 7% of subjects (60/855) with normal PFTs had a persistent empiric COPD diagnosis.
• 24% of subjects (208/855) with normal or restrictive PFTs received persistent empiric treatment.
• Factors associated with diagnosis included smoking history and older age; factors for treatment included empiric diagnosis, female sex, smoking, and other respiratory conditions.

Conclusions:

• A 7% prevalence of persistent empiric COPD diagnosis exists in patients without obstruction on PFTs.
• Persistent empiric treatment for COPD is common (24%) in this population.
• These findings underscore the need for careful review of COPD diagnoses and treatments when PFTs do not support obstruction.