The Prevalence Of Chronic Obstructive Pulmonary Disease (COPD) In A General Medicine Service

Background COPD is one of the leading causes of morbidity and mortality worldwide and imparts a substantial economic burden on individuals and society. In the United States, morbidity caused by COPD is 4%, making COPD the fourth leading cause of death, exceeded only by heart attacks, cancer, and stroke. In china, morbidity caused by COPD is very high. The identification of airflow obstruction is essential for identifying patients who may have COPD. Early diagnosis of COPD may have important benefits to patients, allowing for initiation of pharmacologic treatments, of appropriate immunizations, and of behavioral interventions. Curiously, while screening tests arc often performed for cardiac, endocrine, hepatic, oncologic, and renal disease, the only routine pulmonary screening test is a chest radiograph, which is of little diagnostic value in the absence of symptoms.Objectives: COPD is a worldwide health problem with major impact on health and economics, and can be easily diagnosed by spirometry. Recent expert panels have emphasized the underreporting and underrecognition of this condition. The goal of this study was to measure the prevalence of COPD in patients admitted to an urban teaching hospital, to determine the frequency of a diagnosis of COPD at admission or discharge and to emphasize the need of spirometry.Methods: Between September and December 2003, retrospective study of 663 patients admitted to a medicine service at the second affiliated hospital, School of Medicine, Zhejiang University. Between September and December 2004, prospectivestudy of 501 patients admitted to a medicine service at the second affiliated hospital, School of Medicine, Zhejiang University, these patients completed bedside spirometry and a questionnaire.Results: 8.4% (56 of 663 patients) had a diagnosis of COPD in 2003; 26.7% (134 of 501 patients) had diagnosis of COPD in 2004, including 6.4% (32 of 501 patients) with a very severe airway obstruction (FEV^sub 1^, < 30% predicted). At hospital discharge, a clinical diagnosis of COPD was present in only 2.7% (1 of 37 patients) with mild airway obstruction (FEV^sub 1^ > 70% predicted), 4.6% (3 of 65 patients) with moderate airway obstruction (FEV^sub 1^ 30 to 69% predicted), 93.8% (30 of 32 patients) with severe airway obstruction (FEV^ sub 1^ < 30% predicted). Only 25.4% (34 of 134 patients) with COPD were diagnosed at admission. Only 23.9% (32 of 134 patients) with COPD were receiving spirometry. Only 31.3% (42 of 134 patients) with COPD were receiving bronchodilator medication at hospital admission or discharge.Conclusions: we found a high prevalence of airway obstruction in an inner-city teaching hospital. The admission history, medications, and discharge summary were not sensitive for detecting airway obstruction or diagnosing COPD. Our study suggests that routine spirometry in hospitalized patients, particularly in those > 45 years old men may be useful to identify patients with airway obstruction and possibly to initiate counseling or appropriate medical treatment.