Utility of predischarge spirometry in AECOPD discharges

Introduction and Methods: BTS/NICE guidelines for managing COPD exacerbation (1.3.41) recommends to measure Spirometry in all patients prior to discharge for those admitted with Acute Exacerbation of Chronic Obstructive Disease (AECOPD). We wondered if this is of any clinical benefit in managing the episode. Our observation was that in those who are known COPD it made no difference and in the new undiagnosed and suspected COPD, we were over diagnosing COPD due to obstructive spirometry during their exacerbation. We compared the inpatient and outpatient spirometry results of 55 current/Exsmokers who were admitted to the hospital with a clinical diagnosis of AECOPD. Results: We analysed their lung function, the results of which are as below. 14/55 did not have Obstructive spirometry even during the admission. 17/55(30%) were labelled as COPD when they didn’t have any obstructive spirometry. 17/45 did not have outpatient lung function for various reasons like death or not attending although 13 did show obstructive spirometry as inpatient. Conclusions and recommendations: Carrying out a spirometry on a known COPD patient during an admission doesn’t add to his management but instead uses up resources and upstages the severity of COPD into GOLD C or D directly. Those with no established diagnosis are likely to be mislabelled and /or upstaged in severity leading to in appropriate management. Although it is an opportunity to enhance the diagnosis, it tends to over diagnose. Those with confirmed COPD, need not have a repeat inpatient spirometry thus freeing up the resources for targeted individualised care plan for better community management.