Abstract
Background: The COPD diagnosis rests on demonstration of airflow limitation in an appropriate clinical setting, while the diagnosis of its exacerbation relies on clinical presentation alone. Not requiring spirometry can potentially lead to diagnostic errors.
Methods: We evaluated clinical characteristics of patients hospitalized with a clinical diagnosis of COPD exacerbation (discharge diagnosis plus exacerbation-directed therapy) and performed spirometry in all before discharge. We then compared characteristics of those above and below our threshold for airflow limitation, FEV1/FVC ≤ 0.70.
Results: Forty-seven patients (age 68 ± 12 years) met criteria for a clinical diagnosis of COPD exacerbation; 37 (79%) had airflow limitation and 10 (21%) did not (mean FEV1/FVC = 0.54 and 0.76, resp.). The groups did not differ in age, gender, smoking history, concurrent asthma or CHF, prednisone-days in the previous year, health status, supplemental O2, or bronchodilator or intravenous diuretic therapy in the hospital. Compared to those with COPD, those without airflow limitation had higher body-mass index (41 vs 29 kg/m2, p = 0.002), more sleep impairment in the COPD Assessment Test (CAT) (2.9 vs 1.8, p = 0.02), and greater Medical Research Council (MRC) dyspnea (2.4 vs 1.8, p = 0.04). All-cause readmissions at 30 days and one year were not significantly different.
Conclusions: About one out of five admitted with a clinical COPD exacerbation did not have corresponding airflow limitation. Obesity appears to be a confounding condition. Non-COPD patients had more dyspnea and sleep disturbance. Subsequent hospitalizations out to one year were similar in both groups.
- Copyright ©ERS 2015