title: Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation.
abstract: BACKGROUND
  Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation.
  
  
  METHODS
  Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.
  
  
  RESULTS
  There was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007).
  
  
  CONCLUSIONS
  Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.
authors.affiliation: University of Illinios at Chicago, Chicago, IL, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Prieto Centurion
authors.forename: Frank
authors.initials: F
authors.lastname: Huang
authors.forename: Edward T
authors.initials: ET
authors.lastname: Naureckas
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Charbeneau
authors.forename: Min J
authors.initials: MJ
authors.lastname: Joo
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008168:Lung / Q000503:physiopathology; D008173:Lung Diseases, Obstructive / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D015203:Reproducibility of Results; D013147:Spirometry / Q000379:methods*