The Effect of a Post-Bronchodilator FEV 1 /FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.

التفاصيل البيبلوغرافية
العنوان:	The Effect of a Post-Bronchodilator FEV 1 /FVC < 0.7 on COPD Diagnosis and Treatment: A Regression Discontinuity Design.
المؤلفون:	Moffett AT, Halpern SD, Weissman GE
المصدر:	MedRxiv : the preprint server for health sciences [medRxiv] 2024 Aug 06. Date of Electronic Publication: 2024 Aug 06.
نوع المنشور:	Journal Article; Preprint
اللغة:	English
بيانات الدورية:	Country of Publication: United States NLM ID: 101767986 Publication Model: Electronic Cited Medium: Internet NLM ISO Abbreviation: medRxiv Subsets: PubMed not MEDLINE
مستخلص:	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 second to forced vital capacity ratio (FEV 1 /FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown. Research Question: What is the effect of a documented post-bronchodilator FEV 1 /FVC < 0.7 on the diagnosis and treatment of COPD? Study Design and Methods: We used a national electronic health record database to identify clinical encounters between 2007 to 2022 with patients 18 years of age and older in which a post-bronchodilator FEV 1 /FVC value was documented. An encounter was associated with a COPD diagnosis if a diagnostic 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. We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV 1 /FVC < 0.7 on COPD diagnosis and treatment. Results: Among 27 817 clinical encounters, involving 18 991 patients, a post-bronchodilator FEV 1 /FVC < 0.7 was present in 14 876 (53.4%). The presence of a documented post-bronchodilator FEV 1 /FVC < 0.7 had a small effect on the probability of a COPD diagnosis, increasing by 6.0% (95% confidence interval [CI] 1.1% to 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 1 /FVC had no effect on the probability of COPD treatment ( - 2.1%, 95% CI - 7.2% to 3.0%). Interpretation: The presence of a documented post-bronchodilator FEV 1 /FVC < 0.7 has only a small effect on the probability that a clinician will make a guideline-concordant diagnosis of COPD and has no effect on corresponding treatment decisions.
معلومات مُعتمدة:	F32 HL167456 United States HL NHLBI NIH HHS
تواريخ الأحداث:	Date Created: 20240816 Latest Revision: 20240820
رمز التحديث:	20240820
مُعرف محوري في PubMed:	PMC11326314
DOI:	10.1101/2024.08.05.24311519
PMID:	39148856
قاعدة البيانات:	MEDLINE

الوصف
DOI:	10.1101/2024.08.05.24311519