Overdiagnosis of COPD: precise definitions and proposals for improvement

Fernández-Villar, Alberto; Soriano, Joan B.; Lόpez-Campos, José Luís

doi:10.3399/bjgp17x690389

Cited by 26 publications

(21 citation statements)

References 15 publications

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“…Despite being a major health problem, existing data on COPD prevalence are limited in many countries, and universally high COPD underdiagnosis 2 or misdiagnosis 3 deprives patients and health authorities of the implementation of adequate preventive and therapeutic measures, in order to avoid its potential serious effects and high costs. 4 In fact, of the 50 sovereign European countries, only 19 (38%) of them have available reliable data on COPD prevalence.…”

Section: Introductionmentioning

confidence: 99%

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

Blanco¹,

Diego²,

Bueno³

et al. 2017

COPD

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Existing data on COPD prevalence are limited or totally lacking in many regions of Europe. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, when real data are few and widely separated. Therefore, in order to represent cartographically the prevalence of COPD in Europe, an IDW interpolation mapping was performed. The point prevalence data provided by 62 studies from 19 countries (21 from 5 Northern European countries, 11 from 3 Western European countries, 14 from 5 Central European countries, and 16 from 6 Southern European countries) were identified using validated spirometric criteria. Despite the lack of data in many areas (including all regions of the eastern part of the continent), the IDW mapping predicted the COPD prevalence in the whole territory, even in extensive areas lacking real data. Although the quality of the data obtained from some studies may have some limitations related to different confounding factors, this methodology may be a suitable tool for obtaining epidemiological estimates that can enable us to better address this major public health problem.

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Section: Introductionmentioning

confidence: 99%

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

Blanco¹,

Diego²,

Bueno³

et al. 2017

COPD

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“…First, a retrospective chart review in US from 1999 to 2008 reported that only 55% patients diagnosed with COPD had completed spirometry. 3,24 Similarly, in Sweden, retrospective chart review between 2000 and 2003 showed that of the patients with a new diagnosis of COPD, only 59% were evaluated with spirometry; of patients who completed spirometry, only 30% met GOLD criteria for the diagnosis of COPD. 4 Similar to these studies, our study confirms the longstanding problems with accurately establishing the diagnosis of COPD based on the "irreversible airflow limitation" as a primary criterion.…”

Section: Discussionmentioning

confidence: 99%

“…These three groups had similar length of follow-up; median time between the initial and the last follow-up visits, worse ( Table 3). All baseline (IV) spirometry, 6MWD, and BMI were similar, but the median mMRC score was significantly higher in the improved groups as compared to the unchanged and worsened groups (median 3; IQR: [3,4] vs median 2; IQR: [1,3] vs median 2 IQR: [1,2], respectively, p=0.002) ( Table 3). The numbers of the subjects with clinically significant positive bronchodilator response per ATS criteria were similar among the three groups, 31% (worsened group), 26% (unchanged group) and 33% (improved group).…”

Section: Characteristics Of the Three Groupsmentioning

confidence: 92%

“…Two of the most challenging aspects in caring for COPD patients are to establish an accurate diagnosis of COPD and to manage complex physiologic derangement associated with COPD. [3][4][5][6][7][8] Even though Global Obstructive Lung Disease initiative (GOLD) has established irreversible airflow limitation measured by spirometry as a minimal diagnostic criterion, diagnosis of COPD is still made inconsistently. 9,10 Only 30-60% of smokers develop COPD, and sporadic use of spirometry has shown to cause highly prevalent misdiagnosis of COPD, thus, leading to inappropriate and ineffective therapeutic interventions.…”

Section: Introductionmentioning

confidence: 99%

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<p>Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD</p>

Mansoor

Obaida

Ballowe

et al. 2020

COPD

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Purpose: Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD. Methods: A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM. Results: Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57-70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1-3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up. Conclusion: Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.

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“…The main aim of the SCAP trial was to validate a simple screening procedure to identify ACS patients with smoking history and at a risk of UCOPD. In the SCAP trial, according to current guidelines, spirometry was systematically applied to overpassing misdiagnosis and under diagnosis [8,9]. This sub-analysis highlighted that UCOPD is already associated with significant changes in endothelial function and on-treatment platelet reactivity.…”

mentioning

confidence: 99%

Endothelial dysfunction and increased platelet reactivity in patients with acute coronary syndrome and undiagnosed COPD: insights into the SCAP trial

et al. 2017

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Overdiagnosis of COPD: precise definitions and proposals for improvement

Cited by 26 publications

References 15 publications

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

<p>Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD</p>

Endothelial dysfunction and increased platelet reactivity in patients with acute coronary syndrome and undiagnosed COPD: insights into the SCAP trial

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