An Associational Investigation Into COPD Diagnosis According to the GOLD Standard at a Single Center

Background: The current standard of diagnosis of COPD includes the use of spirometry to assess the degree of airflow obstruction. An accurate diagnosis of COPD is required to ensure that a holistic management plan is tailored to the needs and abilities of the patient. However, there remain several barriers to obtaining diagnostic spirometry. These barriers mean that many patients receive a diagnosis based on a physician’s assessment of symptoms and past medical history. Although clinical assessment is a key factor in the diagnosis of COPD, the lack of spirometry leaves a gap in patient care which may contribute to exacerbation, return hospital visits, and overall cost. This research aimed to understand how many patients within the NMC Health system have been accurately diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) standards for diagnosis, including spirometry. Methods: Adult patients admitted to NMC Health between August 2022 and April 2023, apart from those admitted to the Family Birthing Center, were provided with a questionnaire to assess chronic respiratory issues. A retrospective chart review was then conducted to isolate patients with a diagnosis of COPD per the IDC definition. Patients were separated into groups to assess which patients had spirometry testing meeting the GOLD COPD guidelines. Charts were also reviewed to assess whether patients had been prescribed respiratory medications to treat COPD. This project received approval from the NMC Health System Board of Directors and the IRB at Boise State University. Results: 188 patients were admitted with a diagnosis of COPD. 183 (97%) patients met the criteria for analysis (39 current smokers, 125 former smokers, and 19 nonsmokers). 40 (20%) patients could confirm participating in diagnostic spirometry. However, 138 (73.4%) patients were receiving at least one respiratory-specific pharmacologic treatment for COPD. Conclusions: There is a gap between the use of spirometry to issue a formal diagnosis of COPD and clinical management within the NMC Health System. Opportunities to improve adherence to the GOLD diagnostic guidelines exist to ensure the use of evidence-based guidelines for diagnosis. Additionally, there are opportunities to review whether pharmacologic interventions prescribed to treat respiratory symptoms are appropriate for the management of COPD in those patients without spirometry testing.