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Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing.

Abstract A small number of people with chronic obstructive pulmonary disease (COPD) receive pulmonary function testing around the time of diagnosis. Because omitting testing increases misdiagnosis, we sought to determine whether health outcomes differed between patients whose COPD was diagnosed with or without pulmonary function testing.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28396329
OWN - NLM
STAT- MEDLINE
DA  - 20170411
DCOM- 20170419
LR  - 20170419
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 14
DP  - 2017 Apr 10
TI  - Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or
      without pulmonary function testing.
PG  - E530-E538
LID - 10.1503/cmaj.151420 [doi]
AB  - BACKGROUND: A small number of people with chronic obstructive pulmonary disease
      (COPD) receive pulmonary function testing around the time of diagnosis. Because
      omitting testing increases misdiagnosis, we sought to determine whether health
      outcomes differed between patients whose COPD was diagnosed with or without
      pulmonary function testing. METHODS: We conducted a longitudinal population study
      of patients with physician-diagnosed COPD from 2005 to 2012 using health
      administrative data from Ontario, Canada. We assessed whether having pulmonary
      function testing around the time of diagnosis was associated with the composite
      outcome of admission to hospital for COPD or all-cause death, using adjusted
      survival analysis. RESULTS: Chronic obstructive pulmonary disease was diagnosed
      in 68 898 patients during the study period; 41.2% of patients received
      peridiagnostic pulmonary function testing. In adjusted analysis, patients who
      underwent testing were less likely to die or be admitted to hospital for COPD
      (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.89-0.94) and
      were more likely to be prescribed an inhaled long-acting bronchodilator than
      patients who did not undergo testing. Subgroup analysis suggested that the
      association of testing and outcomes was confined to patients with COPD diagnosed 
      in the ambulatory care setting (adjusted HR 0.80, 95% CI 0.76-0.84).
      INTERPRETATION: Confirmation of a COPD diagnosis using pulmonary function testing
      is associated with a decreased risk of death and admission to hospital for COPD. 
      In ambulatory patients, this effect may be from increased use of appropriate COPD
      medications. The findings of this study validate current guideline
      recommendations that encourage pulmonary function testing for diagnosis in all
      patients with suspected COPD.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Gershon, Andrea
AU  - Gershon A
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont. [email protected]
FAU - Mecredy, Graham
AU  - Mecredy G
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont.
FAU - Croxford, Ruth
AU  - Croxford R
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont.
FAU - To, Teresa
AU  - To T
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont.
FAU - Stanbrook, Matthew B
AU  - Stanbrook MB
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont.
FAU - Aaron, Shawn D
AU  - Aaron SD
AD  - Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To,
      Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health
      Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of
      Public Health (To), University of Toronto; The Hospital for Sick Children (To);
      University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research
      Institute (Aaron), University of Ottawa, Ottawa, Ont.
CN  - Canadian Respiratory Research Network
LA  - eng
PT  - Journal Article
DEP - 20161114
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
SB  - AIM
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cause of Death
MH  - Comorbidity
MH  - Databases, Factual
MH  - Female
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Logistic Models
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Ontario/epidemiology
MH  - Proportional Hazards Models
MH  - Pulmonary Disease, Chronic Obstructive/*diagnosis/*mortality
MH  - Respiratory Function Tests/*utilization
MH  - Survival Analysis
PMC - PMC5386846
EDAT- 2017/04/12 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/12 06:00
PHST- 2016/11/14 [received]
PHST- 2016/09/14 [accepted]
AID - cmaj.151420 [pii]
AID - 10.1503/cmaj.151420 [doi]
PST - ppublish
SO  - CMAJ. 2017 Apr 10;189(14):E530-E538. doi: 10.1503/cmaj.151420. Epub 2016 Nov 14.

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