Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.There was an almost perfect agreement for acceptability (κ？=？0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p？=？0.007).Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.Exacerbations of asthma or chronic obstructive pulmonary disease (COPD), the most common obstructive lung diseases, account for more than one million hospitalizations and nearly six million hospital days each year in the US alone [1-4]. Readmission rates at 30 days, following hospitalization for asthma and COPD exacerbations, are approximately 10% and 20%, respectively [5-7]. Readmission rates at 90-days in patients with COPD exacerbations are estimated to be about 35% [8]. In-hospital mortality for patients admitted with asthma or COPD exacerbations ranges from 0.2% to 38%; higher mortality rates correspond to populations with a greater acuity of illness