How often was COPD missed or incorrectly diagnosed in these hospital patients—and was it associated with peripheral artery disease?

Details

The primary aim was to determine how common confirmed chronic obstructive pulmonary disease (COPD) was among patients aged 45 years or older admitted to the internal medicine ward of HFR Fribourg, a tertiary care hospital in Switzerland, who were either labeled as having COPD or considered at risk. A secondary aim was to determine the prevalence of coexisting COPD and peripheral artery disease (PAD) in this population.

This observational hospital-based prevalence study evaluated all consecutive patients aged 45 years or older admitted to the ward between November 2013 and March 2014. Patients were evaluated for inclusion if their electronic medical record listed COPD, chronic bronchitis and/or lung emphysema—the group “tagged” as COPD—or if they identified at least one classic COPD symptom and one classic risk factor on a checklist—the at-risk group. Once each patient was clinically stable, the researchers performed spirometry and measured the ankle-brachial index (ABI), with toe-brachial index measurement when necessary.

Of 888 consecutive patients, 172 were included. COPD was found in 81 patients. Among the 75 patients tagged as having COPD, 65 (87%) had confirmed COPD and 10 (13%) had a false diagnosis. COPD was diagnosed in 16 (16%) of the 97 at-risk patients.

PAD was identified in 35 (43%) of the patients with confirmed COPD and in 22 (24%) of those without COPD. The association between COPD and PAD was statistically significant (p <0.01).

The authors concluded that COPD was identified in 9% of the 888 patients evaluated. Most patients tagged as having COPD were accurately diagnosed, while a substantial proportion of at-risk patients were underdiagnosed. They also concluded that COPD and PAD were significantly associated. In smokers, they described spirometry showing COPD as a useful test for identifying patients at higher cardiovascular risk, and suggested offering PAD screening using ABI to every smoker with confirmed COPD.