Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice

Abstract

Objectives: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post‐bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. Design, setting and participants: General practitioners from practices in Sydney identified eligible patients aged 40–80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Main outcome measures: Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. Results: 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49% male). Of these, 257 (57.8%) had post‐bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. Conclusions: A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.

Evaluation of the chronic obstructive pulmonary disease assessment test in Japanese outpatients

“…The studies by Jones et al . were performed by general practitioners, and some studies have demonstrated that results of spirometry performed by general practitioners are not always trustworthy . In contrast, spirometry in our study was performed by well‐trained medical staff using standard methods.…”

Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

“…Recent studies of spirometry in the primary care setting have shown that up to 50% of patients with a physician diagnosis of COPD did not meet the criteria for the diagnosis by spirometry [21-23]. Similarly, a recent study showed that more than 30% of patients with a physician diagnosis of stable asthma did not meet the criteria for the diagnosis when tested with a combination of spirometry and methacholine challenge test [24].…”

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].…”