Don't Diagnose Mild COPD Without Confirming Airway Obstructionafteran Inhaled Bronchodilator

Interpreting spirometry: the basics

The ability to accurately obtain and interpret spirometry is essential for physicians caring for patients with asthma and inflammatory disease of the airway. This article reviews the basic equipment, setting, and personnel needed to obtain quality spirometric data. The fundamental measurements obtained in routine office spirometry and recommendations that are critical to obtaining high-quality reproducible test results are reviewed. The evaluation of flow-volume loops and normative data is discusses as well as criteria that define a quality measurement. Examples of normal spirometric data as well as data from different disease states are reviewed.

Added burden of mental disorders on health status among patients with chronic obstructive pulmonary disease

OBJECTIVE

Patients with chronic obstructive pulmonary disease (COPD) and comorbid mental disorders are known to have worse health status. The association between these variables remains complex and poorly understood. We sought to better understand the association between COPD severity, mental disorders (depression/anxiety), and health status.

METHOD

This cross-sectional study compared participants without COPD or with mild COPD (n = 162) to those with moderate (n = 25), severe (n = 38), and very severe (n = 26) COPD. We recruited participants from a primary care and a pulmonary clinic at a veterans affairs medical center between July 2001 until September 2002. We used the Patient Health Questionnaire to screen for depression and anxiety and the Posttraumatic Stress Disorder Checklist to screen for posttraumatic stress disorder. Health status was assessed with the veteran's version of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and the Shortness of Breath Questionnaire (SOBQ).

RESULTS

COPD severity was associated with worse physical status and dyspnea as measured by the SF-36 physical component summary and the SOBQ but was not associated with worse mental status as measured by the SF-36 mental component summary. At each level of COPD severity, participants with mental disorders had worse health status and dyspnea as measured by the SF-36 physical component summary, mental component summary, and SOBQ. Significant linear trends with COPD severity were associated with increased prevalence of any depressive disorder, major depressive disorder, and nonpanic/non-PTSD anxiety disorders (all tests for linear trend, P < .01).

CONCLUSIONS

Independent of COPD severity, comorbid mental disorders were associated with worse health status and dyspnea. Studies are needed to determine whether patients with comorbid mental disorders may have more significant improvement in physical symptoms and functioning if providers focus more on psychiatric conditions.