Methacholine Challenge Testing - Identifying Its Diagnostic Role, Testing, Coding, And Reimbursement
airway; asthma; bronchial hyperresponsiveness; clinical-practice guidelines; coding; cough; function test; General & Internal Medicine; histamine; management; practice management; private practice; pulmonary; reimbursement; Respiratory System; responsiveness; sensitivity; smokers; spirometry
Methacholine challenge testing (MCT), also sometimes described as bronchoprovocation testing, is widely performed for both research and diagnostic purposes. MCT is clinically useful when the patient presents with a history of symptoms suggesting asthma, but spirometry findings are normal. Typically, MCT is performed in a pulmonary function laboratory, a clinic, or a physician's office. MCT requires time, effort, and understanding. Two standard testing regimes are identified along with proper coding and reimbursement methodologies.
Birnbaum S; Barreiro T J
Chest
2007
2007-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1378/chest.06-1385" target="_blank" rel="noreferrer noopener">10.1378/chest.06-1385</a>
Methacholine Challenge Testing - Identifying Its Diagnostic Role, Testing, Coding, And Reimbursement
airway; asthma; bronchial hyperresponsiveness; clinical-practice guidelines; coding; cough; function test; General & Internal Medicine; histamine; management; practice management; private practice; pulmonary; reimbursement; Respiratory System; responsiveness; sensitivity; smokers; spirometry
Birnbaum S; Barreiro T J
Chest
2007
2007-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1378/chest.06-1385" target="_blank" rel="noreferrer noopener">10.1378/chest.06-1385</a>
Office Management of COPD in Primary Care: A 2009 Clinical Update
chronic obstructive pulmonary disease; spirometry; asthma; General & Internal Medicine; risk-factors; randomized; follow-up; controlled-trial; double-blind; obstructive pulmonary-disease; questionnaire; differentiating copd; dyspnea; receptor partial agonist; smoking-cessation; sustained-release bupropion; symptom-based; tobacco smoking
Primary care physicians (PCPs) usually are the first to diagnose and care for patients with chronic obstructive pulmonary disease (COPD). This article discusses key teaching points of recently published guidelines for PCPs and the common challenges of treating COPD patients in a primary care setting, and clarifies common misconceptions. First, PCPs should choose one of the published screening tools to assess for COPD. Spirometry is a useful tool to confirm the diagnosis of COPD to distinguish COPD from asthma, to stage the disease for determining treatment, and it can help with smoking cessation efforts. Chest radiographs do not help to diagnose COPD but are useful to rule out other causes of dyspnea and cough. Differentiating COPD from asthma is important because it affects treatment decisions and prognosis. Second, the goals of COPD treatment are to relieve symptoms, improve exercise tolerance, prevent exacerbations, and improve quality (although not necessarily extend quantity) of life. Chronic obstructive pulmonary disease can be treated at any stage, and the treatments are adjusted in a stepwise approach based on disease severity. Third, as part of the long-term management of COPD, smoking cessation should be discussed at every visit, and inhaler technique should be reviewed at regular intervals. Chronic obstructive pulmonary disease patients should also receive the recommended influenza and pneumococcal vaccinations. Primary care physicians are in a unique position to identify COPD patients early, to implement primary and secondary preventive measures, and to provide care that addresses the full spectrum of COPD and its comorbidities.
Belfer M H
Postgraduate Medicine
2009
2009-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3810/pgm.2009.07.2034" target="_blank" rel="noreferrer noopener">10.3810/pgm.2009.07.2034</a>
Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population.
Adult; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Predictive Value of Tests; Prevalence; *Diagnostic Errors; *Medically Underserved Area; Ohio/epidemiology; *Vulnerable Populations; *Spirometry; Bronchodilator Agents/administration & dosage; Cholinergic Antagonists/administration & dosage; chronic obstructive pulmonary disease; COPD; Forced Expiratory Volume; Lung/drug effects/*physiopathology; Medically Uninsured; misdiagnosis; over diagnosis; Smoking/adverse effects/epidemiology; spirometry; underserved; uninsured; Vital Capacity; Administration; Pulmonary Disease; Inhalation; Chronic Obstructive/*diagnosis/drug therapy/epidemiology/physiopathology
INTRODUCTION: While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking. OBJECTIVE: The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center. METHODS: A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%. RESULTS: Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction. CONCLUSION: Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.
Ghattas Christian; Dai Allen; Gemmel David J; Awad Magdi H
International journal of chronic obstructive pulmonary disease
2013
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2147/COPD.S45693" target="_blank" rel="noreferrer noopener">10.2147/COPD.S45693</a>