Validation of Chronic Obstructive Pulmonary Disease (COPD) Algorithm

Guideline based therapy for COPD includes bronchodilators in conjunction with smoking cessation, vaccination and pulmonary rehabilitation. Bronchodilators have repeatedly been shown to improve symptoms, lung function and quality of life and to reduce exacerbations and possibly mortality in individuals with documented COPD. Despite these findings, the US Preventive Services Task Force recommends against screening for COPD because its value has not been demonstrated in "asymptomatic" individuals. Symptoms such as cough, dyspnea, and wheezing are nonspecific and are common in other disorders such as asthma, kidney failure, and heart disease. Furthermore, COPD is an indolent disease, allowing accommodation to the slowly progressive symptoms. To address this significant under-diagnosis problem, the Global Obstructive Lung Disease (GOLD) Committee recommends "targeted case finding" for patients at risk. Smoking is a risk factor for COPD; however, a quarter of COPD patients are never smokers. The GOLD Guidelines suggest two assessment tools, these tools are designed to detect early symptomatic disease with physician administered patient questionnaires, limiting their use for automated, widespread screening.

Risk stratification tools relying entirely on existing, structured Electronic Health Record (EHR) data would provide an opportunity for screening interventions. The most efficient EHR tool would not include symptoms as a predictor variable since the documentation of symptoms are inconsistent and are typically recorded in unstructured text. Automated screening facilitates targeted screening of high-risk patients, including those individuals with limited contact with the health system. This study has created an accurate tool for this purpose that was cross-validated on a potentially biased set of patients who already underwent spirometric testing.

Inclusion criteria

• greater thank or equal to 40 years of age
• 2 or more encounters in the health system
• Previous Pulmonary Function Test (PFT) recorded in our Electronic Health Records (EHR) in the previous 5 years

Exclusion criteria

• cystic fibrosis
• Alpha-1 Antitrypsin Deficiency (AAD)currently pregnant
• History of a lung transplant or partial removal of the lung
• significant chest wall deformity
• neuromuscular disease that currently impacts the respiratory muscles
• surgery requiring general anesthesia or an overnight stay in the hospital within the past 30 days