COPD Is Overdiagnosed in Hospitalized Patients, Study Finds

Chronic obstructive pulmonary disease (COPD) is typically diagnosed through a patient history exam and a physical exam; however, because symptoms of COPD—dyspnea, cough, and wheeze—are common symptoms for many other diseases, many patients are misdiagnosed due to the lack of necessary testing performed to confirm the presence of the disease.

A study recently published in International Journal of Chronic Obstructive Pulmonary Disease, collected data from patients admitted to a hospital with COPD from January 2011 through December 2013 as a leading diagnosis for their respiratory symptoms. Of the 6018 patients admitted, 504 (8.4%) patients had spirometry assessment, a lung function test, of their pulmonary function and were further studied. The historical data included considered the patients’ demographics, and smoking history.

“The history and physical examination are nonspecific and not sufficient to make a confident diagnosis of COPD. Spirometry is a simple, widely available, inexpensive, bedside, safe, and standardized test with international guidelines,” the authors explained. “In contrast to other common diagnoses like congestive heart failure, which must be verified with echocardiography, there are no quality control measures that enforce the documentation of COPD by using spirometry.”

The authors found that 270 patients (69.2%), treated as having COPD during their hospitalization, were confirmed to have the disease through spirometry, the study results revealed. Additionally, 104 patients (26.6%) were actually had restrictive lung disease and 16 patients (4.2%) had normal assessments.

The smoking history was found to vary significantly between those diagnosed with COPD compared with other diagnoses. Those with COPD were more likely to be current or previous smoked, while those without COPD were likely to have never smoked. More specifically, a higher pack per year history had a greater correlation of COPD diagnoses.

“The suspicion for a proper diagnosis of COPD should be higher in current and former smokers, those with higher pack-year smoking history, and low [body mass index],” the researchers concluded. “However, regardless of suspicion, more patients should have confirmatory testing performed while in the hospital to avoid misdiagnosis.”

Additional studies are needed to determine why spirometry is not often used in hospitalized patients despite evidence of its accuracy and effectiveness in identifying COPD.