Factors associated with undiagnosed and overdiagnosed COPD

Abstract

Worldwide, studies have shown that about 60-86% of people with chronic obstructive pulmonary disease (COPD) have not been diagnosed, which represents a missed opportunity to decrease disease burden through optimal management, including smoking cessation support and prescription medications [1][2][3]. Overdiagnosed COPD is also common, with prevalence estimates ranging from 4% to 64% in the general population and primary care settings [4,5]. Overdiagnosis can lead to unnecessary COPD treatments with their own risks and costs, poor health-related quality of life and missed detection and treatment of other diseases [6].Misdiagnosed COPD indicates that an inaccurate label has been applied, either by not diagnosing COPD (false negative) or diagnosing COPD in someone who does not have it (false positive). Pulmonary function testing helps to avoid such errors [1]. Previous studies have examined factors that differentiate people with diagnosed COPD (true positives) from people without COPD (true negatives) and from people with undiagnosed COPD (false negatives) [7][8][9]. However, a clinician meeting a patient for the first time would benefit from being aware of factors that differentiate overdiagnosed from correctly diagnosed COPD (false from true positives) and undiagnosed from no COPD (false from true negatives). The objective of the current study was to determine these factors.

The Quebec Respiratory Health Education Network: Integrating a model of self-management education in COPD primary care

“…The diagnosis of COPD in subjects without spirometric evidence of airflow obstruction is common in primary care. 29 As such, we consider that our results reflect the reality of COPD management in primary care and further support the importance of the use and appropriate interpretation of spirometry in the diagnosis of COPD. On the other hand, we have demonstrated that education programs by trained health-care professionals, acting as case manager, are feasible to implement in FMCs.…”

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

“…Young and colleagues [49] argued for a widespread use of spirometry screening for airflow obstruction in asymptomatic smokers, in an attempt to appropriately evaluate the prevalence of COPD and detect individuals at an increased risk for lung cancer early. Some identified determinants of under-diagnosed COPD include male sex, lower level of education, being of ethnic minority, and lower comorbidity burden [45, 46, 50], while younger age, being overweight, and higher levels of comorbidities are risk factors for COPD misdiagnosis [50–52]. Therefore, individuals with these characteristics should be offered spirometry for a correct diagnosis of COPD, which in turn will allow for further risk stratification in lung cancer screening [53].…”

The Canadian Cohort Obstructive Lung Disease (CanCOLD): New Insights for Primary Care Application

“…The largest contribution of COLD/Can-COLD-related publications may be seen to have advanced knowledge and understanding surrounding appropriate diagnostic approaches and disease characterisation with impact on recommendations for health care services and interventions. More specifically, the larger proportion of studies to date have served to appropriately quantify COPD prevalence and disease determinants 3,4 spirometry testing and prediction equations [5][6][7][8][9] , diagnosis performance and early detection [10][11][12][13][14][15] , novel methods of assessing COPD 16,17 , and COPD clinical impact [18][19][20][21][22] . Consequently, we have elected for this manuscript to summarise key learnings from the CanCOLD study that are relevant to the primary care setting.…”