Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) and asthma are underdiagnosed in primary care. AimTo determine how often COPD or asthma are present in middle-aged and older patients who consult their GP for persistent cough. Design of studyA cross-sectional study in 353 patients older than 50 years, visiting their GP for persistent cough and not known to have COPD or asthma. SettingGeneral practice in the Netherlands. MethodAll participants underwent extensive diagnostic workup, including symptoms, signs, spirometry, and body plethysmography. All results were studied by an expert panel to diagnose or exclude COPD and/or asthma. The reproducibility of the panel diagnosis was assessed by calculation of Cohen's κ statistic in a sample of 41 participants. ResultsOf the 353 participants, 102 (29%, 95% confidence interval [CI] = 24 to 34%) were diagnosed with COPD. In 14 of these 102 participants, both COPD and asthma were diagnosed (4%, 95% CI = 2 to 7%). Asthma (without COPD) was diagnosed in 23 (7%, 95% CI = 4 to 10%) participants. Mean duration of cough was 93 days (median 40 days). The reproducibility of the expert panel was good (Cohen's κ = 0.90). ConclusionIn patients aged over 50 years who consult their GP for persistent cough, undetected COPD or asthma is frequently present.

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

“…The GPs only registered data on patients willing to participate, and not on all subjects presenting with cough. The study protocol has been described in detail previously, except that patients with 'diagnosed asthma' were excluded in a previous analysis, 10 while they were included in the present analysis.…”

COPD detected with screening: impact on patient management and prognosis

“…However, current guidelines advocate that physicians should pay special attention to the fact that older people do not always report their respiratory complaints and that, in general, spirometry should be considered more often [2]. Moreover, underdiagnosis of COPD, especially in community-dwelling older primary care patients, has been frequently reported [10][11][12].…”

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

“…described in detail elsewhere. 4 Briefly, inclusion criteria for patients were being aged over 50 years and consulting their primary care physician for complaints of cough for 14 days or longer. Exclusion criteria were known COPD, suspected pneumonia, and terminal illness.…”

“…1,2 Spirometry is very important, but results can only be interpreted in combination with symptoms and signs. There is substantial underdiagnosis of COPD in primary care, 3,4 and awareness of possible COPD in symptomatic patients is recommended. 1 However to perform spirometry in all patients with respiratory complaints is neither efficient nor feasible.…”