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How important is spirometry for identifying patients with COPD appropriate for palliative care?

  • Allison V. Lange
    Correspondence
    Corresponding author: Allison Lange, 12700 E 19th Avenue, 9C03, Aurora, Colorado, United States, 80045,
    Affiliations
    Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine; University of Colorado Anschutz Medical Campus; Aurora, Colorado
    Search for articles by this author
  • Anuj B. Mehta
    Affiliations
    Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine; University of Colorado Anschutz Medical Campus; Aurora, Colorado

    Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health and Hospital Authority; Denver, Colorado
    Search for articles by this author
  • David Bekelman
    Affiliations
    Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center; Aurora, Colorado

    Denver-Seattle Center of Innovation; Rocky Mountain Regional Veterans Affairs Medical Center; Aurora, Colorado

    Division of General Internal Medicine, Department of Medicine; University of Colorado Anschutz Medical Campus; Aurora, Colorado
    Search for articles by this author

      Abstract

      Context

      Providing palliative care to patients with chronic obstructive pulmonary disease (COPD) is a priority. Spirometry demonstrating airflow limitation is a diagnostic test for COPD and a common inclusion criterion for palliative care research. However, there are barriers to spirometry, and requiring spirometry with airflow limitation may exclude appropriate patients unable to complete spirometry, or patients with preserved-ratio impaired spirometry and symptoms or imaging consistent with COPD.

      Objectives

      To determine differences in quality of life (QOL) and symptoms between patients with COPD identified based on International Classification of Diseases (ICD) codes and spirometry with airflow limitation compared to ICD codes only.

      Methods

      Patients with COPD enrolled in a palliative care trial were included. Patients were at high risk of hospitalization and death and reported poor QOL. Baseline measures of QOL (Functional Assessment of Cancer Therapy–General (FACT-G), the Clinical COPD Questionnaire, and Quality of Life at the End of Life), and symptoms (Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, fatigue, Insomnia Severity Index) were compared.

      Results

      208 patients with COPD were predominantly male, white, and average age was 68.4. Between patients with ICD codes and spirometry with airflow limitation compared to patients with ICD codes only, there were no significant differences in FACT-G (59.0 v. 55.0, p=0.33), other measures of QOL, or symptoms between groups.

      Conclusion

      These results imply that spirometry may not need to be a requirement for inclusion into palliative care research or clinical care for patients with poor quality of life and at high risk for adverse outcomes.

      Keywords

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