American College of Chest Physicians, Oct. 19-23

The 85th Annual Meeting of the American College of Chest Physicians

The annual meeting of the American College of Chest Physicians was held from Oct. 19 to 23 in New Orleans and attracted approximately 6,000 participants from around the world, including specialists and other health care professionals. The conference featured presentations focusing on clinical updates in chest medicine, including advances in pulmonary, critical care, and sleep medicine.

In one study, Srinadh Annangi, M.D., of the University of Kentucky School of Medicine in Lexington, and colleagues examined whether the underutilization of bronchodilator testing plays a role in the overdiagnosis of chronic obstructive pulmonary disease (COPD). Specifically, the investigators evaluated the role of bronchodilator testing in identifying COPD patients with possible asthma-COPD overlap syndrome, a phenotype of COPD that warrants different management strategies from COPD alone.

The researchers found that using the prebronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio in identifying COPD may lead to COPD overdiagnosis in 39 percent of patients.

“This will not only lead to inappropriately being treated for COPD and resource utilization but also delay in identifying alternate possible reasons for the patient’s symptoms,” Annangi said. “Bronchodilator testing along with other clinical findings will also enable physicians to identify COPD subjects with possible asthma-COPD overlap syndrome, found in 7 to 19 percent of subjects with COPD.”

Furthermore, the investigators found that bronchodilator testing may identify 5 percent of patients with a possible asthma diagnosis who would otherwise be mislabeled as COPD if the prebronchodilator FEV1/FVC ratio is used to diagnose COPD.

“We acknowledge the retrospective nature of this study, but that does not undermine the clinical importance of our study findings,” Annangi concluded. “Further studies should focus on two things — identifying barriers among health care providers towards performing bronchodilator testing and to overcome those barriers. Second, prospectively follow subjects who were diagnosed as COPD based on the prebronchodilator FEV1/FVC ratio for clinical outcomes, including symptom improvement and possible delay in identifying an alternate diagnosis attributable to their initial symptoms.”

Abstract
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In another study, Scott Bickel, M.D., of the University of Louisville School of Medicine in Kentucky, and colleagues found that children who switched asthma inhaler types (standard metered dose inhalers to breath-actuated dry powder inhalers) due to changes in the insurance formulary were observed to have a significant decline in lung function.