COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

Abstract

BackgroundAcknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.ObjectivesTo assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.MethodsCOPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed.Results1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I–II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry.ConclusionsCOPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.

Characterising undiagnosed chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Lastly, we conducted 3 3 6 several pooled analyses to assess the sensitivity of our findings to alternate definitions of 3 3 7 COPD (fixed ratio and LLN) and analysis methods (unadjusted and adjusted analyses). Except for one study, 23 our findings were consistent.…”

“…review, Herrera et al 23 found that respiratory symptoms were not associated with the likelihood of having received a diagnosis of COPD. In the adjusted analysis, these results…”

“…expected to reduce the effects sizes compared to odds ratios derived from contingency tables (as in the unadjusted analysis), one study in the adjusted analysis 23 had unusual results that received disproportionate weighting. In contrast to all other studies in this…”

“…Regression models were adjusted for age (Herrera, Hill, 23 reported prevalence ratios from Poisson regression models.…”

Calidad de vida relacionada con la salud en personas chilenas con enfermedad pulmonar obstructiva crónica

“…con la baja sensibilidad y especificidad que subyacen a los sín-tomas. Algunos estudios epidemiológicos latinoamericanos demuestran que el diagnóstico clínico de EPOC tiene baja sensibilidad y especificidad 34,35 . Ya que, en consecuencia, no puede asumirse con certeza, que la totalidad de los participantes estuviera diagnosticado de EPOC correctamente, sería muy beneficioso para la comunidad científica si en futuras encuestas nacionales de salud, se pudieran precisar tanto la presencia de enfermedad como la severidad de los síntomas.…”