Airway Obstruction Is Common but Unsuspected in Patients Admitted to a General Medicine Service

Study objectives: Obstructive lung disease (OLD) is a worldwide health problem with major impact on health and economics, and can be easily diagnosed by spirometry. Recent expert panels have emphasized the underreporting and underrecognition of this condition. The goal of this study was to measure the prevalence of airway obstruction in patients admitted to an urban teaching hospital and to determine the frequency of a diagnosis of OLD at admission or discharge. Methods: Prospective study of 153 patients admitted to a medicine service at the Johns Hopkins Hospital in Baltimore, MD. Patients completed bedside spirometry and a questionnaire. Results: Twenty-six percent of patients had airway obstruction (FEV₁/FVC < 70%), including 6% with a very severe airway obstruction (FEV₁ < 30% predicted). At hospital discharge, a clinical diagnosis of OLD was present in only 33% of patients with mild airway obstruction (FEV₁ > 70% predicted), 30% of patients with moderate airway obstruction (FEV₁ 50 to 69% predicted), 33% of patients with severe airway obstruction (FEV₁ 30 to 49% predicted), and 89% of patients with very severe airway obstruction (FEV₁ < 30% predicted). Only 40% of patients with airway obstruction were receiving bronchodilator medication at hospital admission or discharge. Conclusions: Airway obstruction is common in hospitalized patients and is usually undiagnosed and untreated. Spirometry may be a useful component of the examination of hospitalized medical patients to identify OLD.