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Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis
Paracelsus Med Univ, Dept Pulm Med, Salzburg, Austria.
Kepler Univ Hosp, Dept Pulmonol, Krankenhausstr 9, A-4021 Linz, Austria;Johannes Kepler Univ Linz, Fac Med, Linz, Austria;Paracelsus Med Univ, Inst Gen Practice Family Med & Prevent Med, Salzburg, Austria.
Paracelsus Med Univ, Dept Pulm Med, Salzburg, Austria.
Paracelsus Med Univ, Dept Pulm Med, Salzburg, Austria;Kepler Univ Hosp, Dept Pulmonol, Krankenhausstr 9, A-4021 Linz, Austria;Johannes Kepler Univ Linz, Fac Med, Linz, Austria.
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2019 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 156, no 2, p. 277-288Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012.

METHODS: A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7).

RESULTS: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication.

CONCLUSIONS: False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.

Place, publisher, year, edition, pages
2019. Vol. 156, no 2, p. 277-288
Keywords [en]
COPD, false positive diagnosis, misdiagnosis, overdiagnosis, overtreatment
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-393117DOI: 10.1016/j.chest.2019.01.015ISI: 000478787900019PubMedID: 30711480OAI: oai:DiVA.org:uu-393117DiVA, id: diva2:1354157
Funder
AstraZeneca
Note

Group Author(s): BOLD Collaborative Res Grp

Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-24Bibliographically approved

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Janson, ChristerOlafsdottir, Inga SifNisser, KatarinaSpetz-Nyström, UlrikeLund, Gun-Marie

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