Scholarlink

Background <p>Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1&#xa0;s to forced vital capacity ratio (FEV<sub>1</sub>/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.</p> Objective <p>To estimate the effect of a documented post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 on the diagnosis and treatment of COPD.</p> Design <p>We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 on COPD diagnosis and treatment.</p> Participants <p>Patients included in a national electronic health record database who were 18&#xa0;years of age and older and had a clinical encounter between 2007 and 2022 in which a post-bronchodilator FEV<sub>1</sub>/FVC value was documented.</p> Main measures <p>An encounter was associated with a COPD diagnosis if an international classification of disease code for COPD was assigned, and was associated with COPD treatment if a prescription for a medication commonly used to treat COPD was filled within 90&#xa0;days.</p> Results <p>Among 27,817 clinical encounters, involving 18,991 patients, a post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 was present in 14,876 (53.4%). The presence of a documented post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 increased the probability of a COPD diagnosis by 6.0% (95% confidence interval [CI] 1.1–10.9%) from 38.0% just above the 0.7 cutoff to 44.0% just below this cutoff. The presence of a documented post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 had no effect on the probability of COPD treatment (−2.1%, 95% CI −7.2 to 3.0%).</p> Conclusions <p>The presence of a documented post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.7 had only a small effect on the diagnosis of COPD and no effect on corresponding treatment decisions.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The effect of a post-bronchodilator FEV1/FVC < 0.7 on COPD diagnosis and treatment: a regression discontinuity design

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年4月1日

查看全文
  • Alexander T. Moffett,
  • Scott D. Halpern,
  • Gary E. Weissman

摘要

Background

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.

Objective

To estimate the effect of a documented post-bronchodilator FEV1/FVC < 0.7 on the diagnosis and treatment of COPD.

Design

We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV1/FVC < 0.7 on COPD diagnosis and treatment.

Participants

Patients included in a national electronic health record database who were 18 years of age and older and had a clinical encounter between 2007 and 2022 in which a post-bronchodilator FEV1/FVC value was documented.

Main measures

An encounter was associated with a COPD diagnosis if an international classification of disease code for COPD was assigned, and was associated with COPD treatment if a prescription for a medication commonly used to treat COPD was filled within 90 days.

Results

Among 27,817 clinical encounters, involving 18,991 patients, a post-bronchodilator FEV1/FVC < 0.7 was present in 14,876 (53.4%). The presence of a documented post-bronchodilator FEV1/FVC < 0.7 increased the probability of a COPD diagnosis by 6.0% (95% confidence interval [CI] 1.1–10.9%) from 38.0% just above the 0.7 cutoff to 44.0% just below this cutoff. The presence of a documented post-bronchodilator FEV1/FVC < 0.7 had no effect on the probability of COPD treatment (−2.1%, 95% CI −7.2 to 3.0%).

Conclusions

The presence of a documented post-bronchodilator FEV1/FVC < 0.7 had only a small effect on the diagnosis of COPD and no effect on corresponding treatment decisions.