Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population

Abstract

IntroductionWhile cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking.ObjectiveThe purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center.MethodsA descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%.ResultsEighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction.ConclusionSymptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.

The Over Diagnosis of COPD in Hospitalized Patients

“…These spirometry studies were also analyzed using the LLN definitions for COPD. 19 Comparing patients with COPD by GOLD and by LLN revealed 29 patients (10.7%) who were classified as having COPD by GOLD who were classified as normal by LLN. Characteristics of those that were not COPD by LLN showed a higher mean age of 75.83 (SD =12.57), compared to 70.08 (SD =12.29, P-value =0.008) ( Table 2).…”

Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

“…IQR ϭ interquartile range with a rate ranging from 27.2-51.6%. 31 Future research may explore the characteristics of overdiagnosed patients to optimize COPD diagnosis.…”

Fatores associados à Doença Pulmonar Obstrutiva Crônica em idosos

“…This was a transversal study based on a population of elderly people numbering 3,954 which involved evaluating the role of the respiratory symptoms in the diagnosis of the obstruction to the flow of air referring to smokers and non-smokers presence in both groups amongst three respiratory symptoms (coughs, wheeziness or chronic sputum) almost doubling the chances of COPD 4 . However just the presence of the respiratory symptoms and smoking are not sufficient for the diagnosis of COPD as it is necessary to confirm the presence of the obstruction through the spirometry test 25,26 . The presence of chronic sputum in COPD is more commonly associated with smoking 1 .…”