Summary of Primary Research Evidence
Jain, V. V., Allison, D. R., Andrews, S., Mejia, J., Mills, P. K., & Peterson, M. W. (2015). Misdiagnosis among frequent exacerbators of clinically diagnosed asthma and COPD in the absence of confirmation of airflow obstruction. Lung, 193(4), 505-512.
Lajas, A. C., González, E. G., Parrado, C. L., Maestu, L. P., & de Miguel-Díez, J. (2018). Readmission Due to Exacerbation of COPD: Associated Factors. Lung, 196(2), 185-193.
Menezes, A. M. B., Perez-Padilla, R., Jardim, J. B., Muiño, A., Lopez, M. V., Valdivia, G., … & PLATINO Team. (2005). Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. The Lancet, 366(9500), 1875-1881
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Regan, E. A., Lynch, D. A., Curran-Everett, D., Curtis, J. L., Austin, J. H., Grenier, P. A., … & Friedman, P. (2015). Clinical and radiologic disease in smokers with normal spirometry. JAMA internal medicine, 175(9), 1539-1549.
Rivas‐Ruiz, F., Redondo, M., González, N., Vidal, S., García, S., Lafuente, I., … & Martínez‐Tapias, J. (2015). Appropriateness of diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation. Journal of evaluation in clinical practice, 21(5), 848-854.
Schneiderman, A. I., Dougherty, D. D., Fonseca, V. P., Wolters, C. L., Bossarte, R. M., &Arjomandi, M. (2017). Diagnosing chronic obstructive pulmonary disease among Afghanistan and Iraq Veterans: Veterans Affair’s concordance with clinical guidelines for spirometry administration. Military medicine, 182(9-10), e1993-e2000.
Shirley, D. K., Kaner, R. J., &Glesby, M. J. (2015). Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study. AIDS patient care and STDs, 29(5), 232-239.
Wells, C. D., &Joo, M. J. (2019). COPD and asthma: Diagnostic accuracy requires spirometry. The Journal of family practice, 68(2).
Appendix A
Summary of Primary Research Evidence
| Citation | Question or Hypothesis | Theoretical Foundation | Research Design (include tools) and Sample Size | Key Findings | Recommendations/ Implications | Level of Evidence |
| Schneiderman, A. I., Dougherty, D. D., Fonseca, V. P., Wolters, C. L., Bossarte, R. M., &Arjomandi, M. (2017). Diagnosing chronic obstructive pulmonary disease among Afghanistan and Iraq Veterans: Veterans Affair’s concordance with clinical guidelines for spirometry administration. Military medicine, 182(9-10), e1993-e2000.
| Are COPD and asthma diagnostics accurate | The study aims to establish if all asthma and chronic obstructive pulmonary disease (COPD)are accurate | A systematic review of descriptive and qualitative studies method was used. In 2 longitudinal studies, patients with asthma diagnosis were recruited to undergo medication reduction and also serial lung function testing | In one study, 31% of patients thought to have OCPD-asthma overlap did not have a single component of COPD. In another study, it was established that at least 22% of adults who were hospitalized for COPD or asthma exacerbations had no evidence of obstruction on spirometry during the time of hospitalization. | It was recommended that there should be increased awareness of clinical practice guidelines coupled with the use and correct interpretation of spirometry since they are needed for optimal management and treatment of COPD and asthma. Additionally, when a patient’s symptoms and risk factors suggest COPD, spirometry is needed to show persistent bronchodilator airflow obstruction and thus confirm the diagnosis. | Level V |
| Shirley, D. K., Kaner, R. J., &Glesby, M. J. (2015). Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study. AIDS patient care and STDs, 29(5), 232-239.
| Or Increased smoking and a detrimental response in tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk of COPD? | The study motive is to determine the predictive value of COPD screening strategy authenticated in the general population and also to identify HIV-related factors that are associated with decreased lung function | The sample size n=2200 The study was carried out in an HIV clinic in New York, where thesubject at least 35 years were to undergo a COPD screening questionnaire and peak flow measurements. Comprehensive medical history was obtained from every subject and every electronic medical record. The evaluation included quantification of smoking exposure, marijuana, and other illicit drug exposure, and a review of both HIV and opportunistic infection history. Each participant also underwent peak flow measurement and completed a five-questionnaire om respiratory (COPD- PS). Peak flow was achieved by standard protocol (ATS/ERS guidelines) by using a vital graph asthma-1 electronic peak flow meter with first graph Safeway disposable mouthpieces, and the most significant value of three attempts was noted.Finally, those with an abnormal questionnaire or peak flow underwent spirometry. One out every three subjects with the standard questionnaire and peak flow results were randomly selected to complete spirometry as a control. Spirometry was completed in line with the standard protocol outlined in ATS/ERS guidelines | The key findings were evidence that at least 125 of the participants had undiagnosed airway obstruction, and 5 had COPD. A combination of positive questionnaires and abnormal peak flow yielded a sensitivity of 20% with a specificity of 93% for the detection of COPD. Peak flow had a sensitivity of 80%, while abnormal peak flow was associated with an AIDS diagnosis (p=0.04). Nadir CD4 count remained related to multivariate analysis (p=0.05). Additionally, both peak flow and questionnaire together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS.Therefore, the data suggest that HIV -related factors may influence lung function. | COPD and other obstructive lung diseases remain undiagnosed in HIV infected individuals.HIV related factors, including poor viral control. And the magnitude of CD4-T cell suppression can influence lung functions, but its recommended that further studies need to be done to elucidate the exact mechanisms. Also, further studies are required to test peak flow in combinations with other clinical or historical factors in the prediction of COPD. | Level 1 |
| Jain, V. V., Allison, D. R., Andrews, S., Mejia, J., Mills, P. K., & Peterson, M. W. (2015). Misdiagnosis among frequent exacerbators of clinically diagnosed asthma and COPD in the absence of confirmation of airflow obstruction. Lung, 193(4), 505-512.
| Are misdiagnoses of asthma and COPD flawed with a lack of objective confirmation of airflow obstruction (AO)? | The study aims to establish a misdiagnosis of a sthma and COPD in clinical diagnosis.
| Sample size n= 342 Patients 18 years and above with frequent severe exacerbations of PD-asthma or PD-COPD between May 2013 and October 2014 were considered for enrollment and evaluated at the chronic lung disease program at the community regional medical center in Fresno, CA. Patients were categorized as having “: uncertain diagnoses ” once a diagnostic agreement could not be reached between the two pulmonologists. | Only 24% of the sample size was found to have baseline post-bronchodilator spirometry. Misdiagnosis was seen in 26% of the patients, while 12% of the patients had obstructive lung diseases other than asthma and COPD. Independent risk factors for misdiagnosis were spirometry underutilization | Objective confirmation of airflow obstruction is very core in cutting off misdiagnosis of asthma and COPD. | Level II |
| Menezes, A. M. B., Perez-Padilla, R., Jardim, J. B., Muiño, A., Lopez, M. V., Valdivia, G., … & PLATINO Team. (2005). Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. The Lancet, 366(9500), 1875-1881.
| Is chronic obstructive pulmonary disease (COPD) the primary cause of both prevalence and mortality rate? | The paper aims to describe the epidemiology ofCOPD in five major Latin American cities | N= 800 people for every area. A two-stage sampling strategy was used in the five areas to obtain probability samples of adults aged 40 years and above. They were then invited for a questionnaire and underwent anthropometry, which was followed by prebronchodilator and postbronchodilator spirometry. | The contact failure rate at the household level was highest in Caracas, while questionnaire completion was lowest in Mexico. Women outnumbered men in all areas. It was established that the prevalence of COPD ranged from 7.8% in Mexico to almost 20% in Montevideo. Further, it was determined that COPD is a much massive problem in Latin America. | Chronic obstructive pulmonary disease should be controlled to reduce the mortality rate. | Level I |
| Regan, E. A., Lynch, D. A., Curran-Everett, D., Curtis, J. L., Austin, J. H., Grenier, P. A., … & Friedman, P. (2015). Clinical and radiologic disease in smokers with normal spirometry. JAMA internal medicine, 175(9), 1539-1549.
| Airflow obstruction on spirometry universally defines chronic obstructive disease (COPD). | The aim is to identify clinical and radiologic evidence of smoking-related disease in the cohort of current and former smokers who did not meet spirometry criteria for COPD | N= 3690 for GOLD O N=794 for GOLD 1 Individuals from the genetic epidemiology of CORP cross-sectional observational study completed spirometry, chest and computed tomography scans, a 6-minute walk, and questionnaires. The participants were majorly recruited from the local communities. | One or more respiratory-related impairments were found in 54.1 % of the GOLD O group. Additionally, the GOLD O group had a worse quality of life. Current smoking was associated with more respiratory symptoms, while former smokers had higher emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of the disease. | More strategies to prevent the development and progression of COPD are needed for the most significant segment in the US. | Level II |
| Lajas, A. C., González, E. G., Parrado, C. L., Maestu, L. P., & de Miguel-Díez, J. (2018). Readmission Due to Exacerbation of COPD: Associated Factors. Lung, 196(2), 185-193.
| What are the factors associated with readmission due to exacerbation of COPD? | It aims to compare the characteristics of patients readmitted aft6er discharge by COPD exacerbation with those who were not readmitted and also identify factors that are associated with readmission risk. | A group of 40 COPD patients with the high frequency of readmissions within 30 days in 2015 and another group of 40 COPD with a low rate of readmission were selected | Patients of HFR group compared to those of LFR were frequently males. The most frequent reason for readmission was a respiratory infection at 78.7% | It is essential to keenly take note of the results to recognize patients who would benefit most from the strategies to reduce cases of readmissions | Level II |
| Wells, C. D., &Joo, M. J. (2019). COPD and asthma: Diagnostic accuracy requires spirometry. The Journal of family practice, 68(2).
| Does COPD and asthma diagnostic accuracy require spirometry | To establish that spirometry is an essential inaccurate diagnosis of COPD and asthma | A review of various studies was conducted to demonstrate the prevalence of diagnostic error. | 35% of patients did not have objective evidence of COPD, while 37% with asthma only diagnosis had a persistent obstruction. Additionally, 31% of patients had asthma- OCPD overlap but did not have a COPD component | It was recommended to use spirometry to support clinical suspicion of asthma or COPD. | Level IV |
| Rivas‐Ruiz, F., Redondo, M., González, N., Vidal, S., García, S., Lafuente, I., … & Martínez‐Tapias, J. (2015). Appropriateness of diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation. Journal of evaluation in clinical practice, 21(5), 848-854.
| Is diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation appropriate? | Aims to establish and asses the adequacy of diagnostic effort in the emergency departments of Spanish hospitals concerning the episodes of exacerbation of chronic obstructive pulmonary disease (COPD) | N=2852 A descriptive cross-sectional study was conducted between 2007 and 2010 in 15 hospitals. The study population involved cases of COPD exacerbation attended at the emergency departments of the participating hospitals.Also, diagnostic efforts were considered sufficient and appropriate when the emergency room conducted an emergency room conducted a clinical evaluation, including the electrocardiogram, chest X-ray, arterial blood gas analysis, and spirometry. | The diagnostic effort was considered adequate in 60.1% of the episodes. The inter-hospital range of variation was 1.67%, and the coefficient of variation was 28.3 %. Inequities were observed in the assessment of episodes of COPD exacerbation attended in the emergency department of Spanish public hospitals. Also, inter-individual and inter-hospital differences were observed. | They recommended that there remains considerable room for improvement in hospital emergency departments. Therefore, measures should be established to reduce differences between hospitals and regions.
| Level VI |
Legend:
Level I: systematic reviews or meta-analysis
Level II: well-designed Randomized Controlled Trial (RCT)
Level III: well-designed controlled trials without randomization, quasi-experimental
Level IV: well-designed case-control and cohort studies
Level V: systematic reviews of descriptive and qualitative studies
Level VI: a single descriptive or qualitative study
Level VII: opinion of authorities and reports of expert committees
Appendix B
Summary of Systematic Reviews (SR)
| Citation | Question | Search Strategy | Inclusion/ Exclusion Criteria | Data Extraction and Analysis | Key Findings | Recommendation/ Implications | Level of Evidence |
| Menezes, A. M. B., Perez-Padilla, R., Jardim, J. B., Muiño, A., Lopez, M. V., Valdivia, G., … & PLATINO Team. (2005). Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. The Lancet, 366(9500), 1875-1881.
| Is chronic obstructive pulmonary disease (COPD) the primary cause of both prevalence and mortality rate? | Veterans eligible for VA health were identified using a roaster file from the DoD defense workforce data center. These inpatient and outpatient encounter records fro Veterans eligible for a VA health were determined using a roaster file from the DoD defense workforce data center the department of veteran affairs national patient care database were queried using international classification of disease | All healthcare records of veterans were assessed to determine whether the COPD cases were associated with the CPG-concordant spirometry test. Veterans with a primary or secondary diagnosis of COPD within six or more months after their initial VA healthcare visit were excluded from the study population. Coast guard members were also ex c | After establishing if the COPD cases were associated with CPG-concordant, the following data were extracted for analytical purpose.: demographic components such as bas sex, race, date of birth, service, and health such a tobacco use disorder and history of tobacco use | Non-concordance was defined as receiving spirometry after the initial COPD diagnosis or having no spirometry procedural code. Coast guard members were also excluded due to low representation. 31% of the study population had CPG-concordant spirometry. Additionally, a positive association was found | Due to the prevalence of COPD, more attention, and action towards the disease were recommended. Additionally, Public awareness about COPD is essential | Level I |
| Schneiderman, A. I., Dougherty, D. D., Fonseca, V. P., Wolters, C. L., Bossarte, R. M., &Arjomandi, M. (2017). Diagnosing chronic obstructive pulmonary disease among Afghanistan and Iraq Veterans: Veterans Affair’s concordance with clinical guidelines for spirometry administration. Military medicine, 182(9-10), e1993-e2000.
| Are COPD and asthma diagnostics accurate | In 2 longitudinal studies, patients with asthma diagnosis were recruited to undergo medication reduction and also serial lung function testing | A retrospective analysis of operations enduring freedom/Iraq Freedom/new dawn veterans who utilized the VA healthcare system between January 2002 and December 2014. Veterans eligible for a VA health were identified using a roaster file from the DoD defense manpower data center | COPD cases were first identified among the veterans. A logistic regression model was used to test the relationship between selected demographic,service, and health characteristics. The model controlled for the age of the initial COPD encounter where a likelihood ratio test was used to determine if age significantly increased the predictive power of the model | In one study, 31% of patients thought to have OCPD-asthma overlap did not have a single component of COPD. In another study, it was established that at least 22% of adults who were hospitalized for COPD or asthma exacerbations had no evidence of obstruction on spirometry during the time of hospitalization. | It was recommended that there should be increased awareness of clinical practice guidelines coupled with the use and correct interpretation of spirometry since they are needed for optimal management and treatment of COPD and asthma. Additionally, when the patient’s symptoms and risk factors suggest COPD, spirometry is needed to show persistent bronchodilator airflow obstruction and thus confirm the diagnosis. | |
Legend:
Level I: systematic reviews or meta-analysis
Level II: well-designed Randomized Controlled Trial (RCT)
Level III: well-designed controlled trials without randomization, quasi-experimental
Level IV: well-designed case-control and cohort studies
Level V: systematic reviews of descriptive and qualitative studies
Level VI: a single graphic or qualitative study
Level VII: opinion of authorities and reports of expert committees