Journal of Ageing, Disability and Chronic Disease – Current Issue
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Article (s)
Volume 2, Issue 1 J Ageing Disabil Chronic Dis 2023, 2:1
Overdiagnosis and Overtreatment of COPD in Individuals 90 Years and Older
OIkuyo Imayama, Mateo Tole, Christian J. Ascoli and Israel Rubinstein
Abstract
Background: Although the prevalence of chronic obstructive pulmonary disease (COPD) increases with age, limited information about the current diagnostic and therapeutic practices in COPD is available in aged individuals. We conducted a retrospective study of adults aged 90 years and older with COPD diagnosis and compared differences in prescribed medications, and steroid or antibiotic use for respiratory symptoms during acute healthcare visits across the four subgroups: 1) without valid spirometry, 2) ratio of forced expiratory volume in one second over forced vital capacity (FEV1/FVC) ratio ≥0.70, 3) FEV1/FVC ratio <0.70 but >age-based lower limit of normal (LLN), and 4) FEV1/FVC ratio <LLN.
Methods: A single-center retrospective study of 90 years and older adults with a diagnosis of COPD. Demographics, medications, medical history, acute healthcare visits (hospitalizations, emergency and urgent care), and spirometry values were extracted. ANOVA, Kruskal Wallis, Chi-square, Fisher and logistic regression tests as appropriate were used to compare differences across the four groups.
Results: Among 166 adults with COPD diagnosis, 71 (43%) did not have a valid spirometry test, 24 (14.5%) had normal post-bronchodilator FEV1/FVC ratio ≥0.70, 28 (16.9%) had LLN ≤ post-bronchodilator FEV/FVC ratio <70%, and 43 (25.9%) had post-bronchodilator FEV1/FVC ratio <LLN. There were no differences in prescribed COPD medications or steroid and antibiotic use during acute health care visits among the four groups. The proportion of patients who had unscheduled healthcare visits within one year for respiratory symptoms differed across the four groups. Individuals with FEV1/FVC<LLN had a significantly higher visit frequency compared to those without spirometry (p<0.05).
Conclusion: Over half of 90 and older veterans were diagnosed with and treated for COPD without substantiating spirometry reports. This may lead to inappropriate prescription of COPD medications.
