Obese patients receive needless respiratory treatment

Dec 3 2013

Research from the USA shows that a substantial proportion of obese patients are prescribed bronchodilators, even after spirometry indicates a lack of lung obstruction.

Analyzing data on 155 obese patients who were referred for spirometry, Spyridon Fortis and colleagues from Bridgeport Hospital and Yale School of Medicine in New Britain, Connecticut, found that a third of those already prescribed a bronchodilator continued to do so despite normal spirometric findings.

“Clearly such patients are exposed to complications and costs of these therapies without proven or plausible clinical benefits,” the team comments in BMC Pulmonary Medicine.

The study also highlighted that half of all obese patients being referred for spirometry were already being prescribed bronchodilators. However, 40% of patients had normal pulmonary testing results, with 45% of patients receiving therapy for misdiagnosed chronic obstructive pulmonary disease (COPD) or asthma.

Nevertheless, 33.9% of 62 patients with normal spirometry results continued to receive these treatments 6 months after testing.

The team also notes substantial pre-spirometry use of other respiratory medications, and among those with subsequently normal results, 40% had received inhaled beta₂-agonists, 16% inhaled corticosteroids, 15% inhaled anticholinergics, 8% oral corticosteroids, and 2% leukotriene antagonists.

Fortis and colleagues suggest that the perseverant treatment of non-obstructed obese patients is less a case of medication error and more a side effect of “systems-based practice,” in which they say diseases are often entered into medical records without proper follow-up or diagnostic confirmation.

“Arguably, the most important message is that diagnoses should not be taken ‘at face value’ and perpetuated in medical records,” they write. “Perhaps, reconciliation of medications and diagnoses will promote safer, patient-centered care.”

Additionally, the team notes that evidence suggests that obesity in itself is more commonly associated with restrictive, as opposed to obstructive, lung disease. Indeed, in their study, 60% of 35 patients with a restrictive pattern on spirometry were wrongly receiving treatment for obstructive disease, and almost all (86%) continued to do so despite spirometry results indicating an alternate diagnosis.

They therefore conclude that “clinicians should exercise greater caution – via confirmatory spirometry – before assigning or perpetuating the label of obstructive lung disease to obese patients.”

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