title: How often is diagnosis of COPD confirmed with spirometry?
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice.
  
  
  METHODS
  In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis +/-6 months were analyzed.
  
  
  RESULTS
  From 1114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in 1s (FEV(1))/ vital capacity (VC) ratios were available in 45% (n=241). FEV1/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV(1)/VC ratio of >/=0.70. The most common problem in the quality assessment was an insufficient exhalation time.
  
  
  CONCLUSIONS
  Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.
authors.affiliation: Primary Care Research Unit, County Council of Värmland, Universitetsgatan 3, SE-656 37, Karlstad, Sweden. mats.arne@medsci.uu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Arne
authors.forename: Karin
authors.initials: K
authors.lastname: Lisspers
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
authors.forename: Gunnar
authors.initials: G
authors.lastname: Boman
authors.forename: Hans
authors.initials: H
authors.lastname: Hedenström
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
authors.forename: Margareta
authors.initials: M
authors.lastname: Emtner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D013147:Spirometry / Q000592:standards*; D055815:Young Adult