Pulmonary Department, Álvaro Cunqueiro Hospital, EOXI, Vigo, Spain.
NeumoVigoI+i Research Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.
PLoS One. 2018 Mar 26;13(3):e0194983. doi: 10.1371/journal.pone.0194983. eCollection 2018.
Although not currently recommended, spirometry during hospitalization due to exacerbation of chronic obstructive pulmonary disease (COPD) is an opportunity to enhance the diagnosis of this disease. The aim of the present study was to assess the usefulness and reliability of spirometry before hospital discharge, comparing it to measurements obtained during clinical stability.
This prospective longitudinal observational study compares spirometry results before and 8 weeks after discharge in consecutive patients admitted for COPD exacerbation. Concordance between results was assessed by the Kappa index, intraclass correlation coefficient, and Bland-Altman graphs.
From an initial population of 179 COPD patients, 100 completed the study (mean age 67.8 years, 83% men, 35% active smokers, FEV1 at clinical stability 40.3%). Forty-nine patients could not complete the study because they did not reach clinical stability. In three patients with obstructive spirometry during admission, the results were normal at follow-up. In the remaining patients, the COPD diagnosis was confirmed at stability with acceptable concordance. In 27 cases, spirometry improved more than 200 mL.No variables were found to be associated with this improvement or to explain it.
This study provides information on the role of spirometry prior to hospital discharge in patients admitted for COPD exacerbation, demonstrating that it is a valid and reproducible method, representing an opportunity toimprove COPD diagnosis.
虽然目前不推荐，但由于慢性阻塞性肺疾病（COPD）加重而在住院期间进行肺功能检查是增强该疾病诊断的机会。本研究旨在评估出院前肺功能检查的有用性和可靠性，并将其与临床稳定期的测量结果进行比较。
这项前瞻性纵向观察性研究比较了连续因 COPD 加重而入院的患者在出院前和 8 周后的肺功能检查结果。通过 Kappa 指数、组内相关系数和 Bland-Altman 图评估结果的一致性。
从最初的 179 例 COPD 患者中，有 100 例完成了研究（平均年龄 67.8 岁，83%为男性，35%为主动吸烟者，临床稳定时的 FEV1 为 40.3%）。49 例患者因未达到临床稳定而无法完成研究。在 3 例入院时存在阻塞性肺功能的患者中，随访时结果正常。在其余患者中，在稳定期确认了 COPD 诊断，且具有可接受的一致性。在 27 例中，肺功能检查改善超过 200 mL。未发现任何变量与这种改善相关或能解释这种改善。
本研究提供了关于因 COPD 加重而入院患者在出院前进行肺功能检查的作用的信息，表明这是一种有效且可重复的方法，为改善 COPD 诊断提供了机会。
