OBJECTIVES: Spirometry is required for chronic obstructive pulmonary disease (COPD) diagnosis and follow-up assessment. This study aimed to examine spirometry utilization among commercially insured individuals with COPD.

METHODS: Individuals with COPD between 2006 and 2015 were identified using the IQVIA PharMetrics® Plus for Academics claims dataset. COPD diagnosis was defined as at least two claims with a code for COPD (ICD-9: 491.xx, 492.xx, or 496.xx) in the outpatient setting or one in the inpatient or emergency room setting. The index date was defined as the date of the first claim coded with COPD. Individuals under 40 years of age or not continuously enrolled in their medical and pharmacy plans for 12 months before and after the index date were excluded. The cohort was split into two groups according to COPD maintenance medication utilization (inhaled corticosteroid, long-acting β2-agonist, long-acting muscarinic antagonist, or phosphodiesterase-4 inhibitors): those who filled at least one prescription for medication during the study period and those who did not. The primary outcome was spirometry performed within 90 days before or after the index date.

RESULTS: A total of 78,582 individuals with COPD were identified. The cohort was 50.62% female, and the mean age was 60 years. The mean Charlson Comorbidity Index was 1.8. 23,374 (29.74%) had spirometry utilization. Of 30,808 (39.20%) who used COPD medication, 12,246 (39.75%) had spirometry versus 11,128 (23.29%) with spirometry out of 47,774 (60.80%) who never used COPD medication (p<0.01).

CONCLUSIONS: The utilization of spirometry within 90 days of COPD diagnosis was less than 30%. Those using COPD medication were more likely to have spirometry than patients without medication use. Further studies are needed to examine the interplay between spirometry and COPD medication prescriptions, especially focusing on how spirometry can be increased to ensure medications are being prescribed appropriately.