How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?

• Published in: Journal of pain and symptom management 2023-03, Vol.65 (3), p.e181-e187
• Main Authors: Lange, Allison V., MD, Mehta, Anuj B., MD, Bekelman, David B., MD, MPH
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; clinical trial; COPD; Female; Hospitalization; Humans; Male; Pain Medicine; Palliative Care; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Spirometry
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.11.016

AbstractBackgroundProviding 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, 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. MeasuresTo 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. InterventionPatients 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. OutcomesTwo hundred eight 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 vs. 55.0, P = 0.33), other measures of QOL, or symptoms between groups. ConclusionThese 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.