Not all that wheezes is asthma (or COPD)!
How is it possible, with supporting literature, along MD groups like American Medical Association (AMA) and even government sponsored spirometry initiatives National Quality Forum (NQF) 0091 COPD Spirometry Evalution (1) stating that spirometry has to be done to “prove” Chronic Obstructive Pulmonary Disease (COPD)/Air Flow Obstruction (AFO), and simple tools like the COPD-population screener, that Primary Care Physician (PCP) offices are STILL neglecting to do a simple test that IS BILLIABLE!
When you go to your PCP and complain of chest pain or tightness, they do an ECG as part and parcel to your visit. Why are we NOT doing spirometry when there’s a complaint of Shortness of Breath (SOB)? Or at the very least- a query/screener like the COPD-ps that can define if we need to perform spirometry or not.
“Kaminsky_all that wheezes is not asthma” shows that anywhere from 20-40% of people labeled as COPD, do not actually HAVE COPD. They were empirically diagnosed and NEVER DID SPIROMETRY. Then there’s the burden of that cost on patient care, mismanagement, and worst of all readmission for something they don’t have.
“VA must do spiro for COPD diagnosis” showed that apprx 40% of patients carrying the empirical diagnosis COPD, were genuinely sick, but NOT with COPD. They fall into these categories, none of which should come as a surprise- Congestive Heart Failure (CHF), obesity, sleep apnea, or hypertension.
Previous studies conclude that only 1/3 of newly diagnosed COPD patient have undergone spirometry. It has been documented many times, that the clinical exam is not adqequate in predicting airflow obstruction, nor can it define the nature of airflow obstruction.
Overall, this type of empirical care is wasteful, inaccurate, ineffective, and certainly not patient centered. COPD strains hospital resources and dollars; imagine the impact to hospital resources, dollars, and most importantly patient quality of life, if only 20% of those patients were properly managed!
When you go to your PCP and complain of chest pain or tightness, they do an ECG as part and parcel to your visit. Why are we NOT doing spirometry when there’s a complaint of SOB? Or at the very least- a query/screener like the COPD-ps that can define if we need to perform spirometry or not.
With the estimates of this disease based on impaired lung function being in the 24million range, we simply cannot afford a single incorrectly diagnosed patient.