How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?

Area of Science:

• Pulmonary Medicine
• Palliative Care
• Clinical Research

Background:

• Palliative care is crucial for patients with chronic obstructive pulmonary disease (COPD).
• Spirometry is a common diagnostic tool and research criterion for COPD, but may exclude eligible patients.
• Exclusion can occur in patients unable to perform spirometry or those with preserved-ratio impaired spirometry but consistent symptoms/imaging.

Purpose of the Study:

• To compare quality of life (QOL) and symptoms in COPD patients identified via ICD codes plus spirometry versus ICD codes alone.
• To assess the impact of spirometry inclusion criteria on palliative care research enrollment.
• To evaluate if spirometry is essential for defining the target population in COPD palliative care.

Main Methods:

• A palliative care trial included patients with COPD at high risk for hospitalization and death.
• Patients were categorized based on International Classification of Diseases (ICD) codes with or without spirometry confirmation of airflow limitation.
• Baseline QOL (FACT-G, CQC, QOL-EOL) and symptom measures (PHQ-8, GAD-7, fatigue, ISI) were compared between groups.

Main Results:

• The study included 208 COPD patients, predominantly male and White, with an average age of 68.4.
• No significant differences in QOL (FACT-G: 59.0 vs. 55.0, P=.33) or symptom burden were found between patients identified with and without spirometry.
• These findings were consistent across other QOL and symptom assessment tools.

Conclusions:

• Spirometry may not be a necessary requirement for including patients in palliative care research or clinical practice.
• Patients with poor QOL and high risk for adverse outcomes, identified by ICD codes alone, can be appropriately included.
• This broadens eligibility for palliative care, ensuring more patients receive necessary support.