title: Serial pulmonary function tests to diagnose COPD in chronic heart failure.
abstract: BACKGROUND
  It is unknown whether serial pulmonary function tests are necessary for the correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients with stable non-congested chronic heart failure (CHF). The aim of this study was to determine the prevalence of COPD in outpatients with stable CHF without pulmonary congestion using initial as well as confirmatory spirometry three months after treatment for COPD.
  
  
  METHODS
  Spirometry was performed in 187 outpatients with stable CHF without pulmonary congestion on chest radiograph who had a left ventricular ejection fraction < 40% (mean age 69 ± 10 years, 78% men). COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. The diagnosis of COPD was confirmed three months after treatment with tiotropium in newly diagnosed COPD patients.
  
  
  RESULTS
  Using a three month follow-up spirometry to confirm initial diagnosis of de novo COPD did not change COPD prevalence significantly: 32.6% initially versus 32.1% after three months of follow-up. Only 1 of 25 (4%) patients with newly diagnosed COPD was not reproducibly obstructed at follow-up. COPD was greatly under- (19%) and overdiagnosed (32%).
  
  
  CONCLUSIONS
  Spirometry should be used under stable and euvolemic conditions to decrease the burden of undiagnosed or overdiagnosed COPD in patients with CHF. Under these conditions, a confirmatory spirometry is unnecessary, as it does not change a newly established diagnosis of COPD in the vast majority of patients with CHF.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier NCT01429376.
authors.affiliation: Department of Pulmonary Diseases, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands ; Department of Pulmonary Diseases, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands.
authors.forename: Armine G
authors.initials: AG
authors.lastname: Minasian
authors.affiliation: Department of Pulmonary Diseases, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
authors.forename: Frank Jj
authors.initials: FJ
authors.lastname: van den Elshout
authors.affiliation: Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Pn Richard
authors.initials: PR
authors.lastname: Dekhuijzen
authors.affiliation: Department of Pulmonary Diseases, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
authors.forename: Petra Je
authors.initials: PJ
authors.lastname: Vos
authors.affiliation: Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
authors.forename: Frank F
authors.initials: FF
authors.lastname: Willems
authors.affiliation: Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
authors.forename: Paul Jpc
authors.initials: PJ
authors.lastname: van den Bergh
authors.affiliation: Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Yvonne F
authors.initials: YF
authors.lastname: Heijdra
keywords: Chronic heart failure; Chronic obstructive pulmonary disease; Overdiagnosis; Prevalence; Serial pulmonary function tests; Underdiagnosis