The following is a summary of the “How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?,” published in the March 2023 issue of Pain and Symptom Management by Lange, et al.

Patients with chronic obstructive pulmonary disease (COPD) should have access to palliative care services. Spirometry showing airflow limitation is used to diagnose chronic obstructive pulmonary disease (COPD) and is often used as an inclusion criterion in studies of palliative care. However, requiring spirometry with airflow limitation may rule out suitable patients who cannot complete the test or those who have preserved-ratio impaired spirometry despite having symptoms or imaging findings suggestive of COPD.

The purpose of this study is to compare patients with COPD identified using International Classification of Diseases (ICD) codes and those identified using spirometry with airflow limitation to determine whether or not the presence of airflow limitation has a significant impact on patient’s quality of life (QOL) and symptoms. Patients with COPD taking part in a palliative care trial were considered. Hospitalization rates were high, and patients’ quality of patient’s also low. Symptoms (Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, fatigue, and Insomnia Severity Index) and quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]; Clinical COPD Questionnaire; Quality of Life at the End of Life) were compared at baseline.

Most of the 238 COPD patients were White men, and their average age was 68.4. There were no statistically significant differences in FACT-G (59.0 vs. 55.0, P = 0.33), other measures of QOL, or symptoms between patients with ICD codes and spirometry with airflow limitation and patients with ICD codes only. The findings suggest that spirometry may not be necessary for patients with poor quality of life and high risk for adverse outcomes to participate in palliative care research or clinical care.