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Patient and physician factors associated with pulmonary function testing for COPD: a population study


Background — The diagnosis of chronic obstructive pulmonary disease (COPD) is made by objectively demonstrating non-reversible airflow obstruction of the lungs. Despite this, rates of pulmonary function testing for diagnosis remain low. It is still not known why testing is under-used.

Methods — The authors conducted a population study using the health administrative data of all individuals age 35 years and older newly diagnosed with COPD in Ontario, Canada between 2000 and 2010. Receipt of pulmonary function testing during the peridiagnostic period (between one year before and one year after a diagnosis of COPD) was determined and related to patient demographic and clinical characteristics as well as primary care physician and healthcare system factors.

Results — Only 35.9% of the 491,754 Ontarians newly diagnosed with COPD during the study period received pulmonary function testing. Individuals diagnosed before age 50 or after age 80, those living in long term care and those with stroke and/or dementia were less likely to receive testing. Patients who had a medical specialist involved in their care and/or had other co-existing pulmonary disease were more likely to receive testing. Finally, older primary care physicians were less likely to order testing for their patients.

Conclusion — Only about one third of individuals with COPD in Ontario, Canada received pulmonary function testing to confirm their diagnosis; age, comorbidity and physician factors appear to influence its use. Targeted strategies that address these factors could increase the rate of appropriate testing of people with suspected COPD and improve quality of COPD care.



Gershon AS, Hwee J, Croxford R, Aaron S, To T. Chest. 2014; 145(2):272-81. Epub 2013 Sep 5.

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