COPD: Should Diagnosis Match Physiology?

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Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis.

To access publisher's full text version of this article click on the hyperlink belowBACKGROUND: 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.Sanofi-Aventis AstraZeneca Boehringer Ingelheim Chiesi GlaxoSmithKline Merck & Company Pfizer Merck & Company Schering Plough Corporation Sepracor University of Kentucky Wellcome Trust Boehringer Ingelheim China. (Guangzhou, China) Turkish Thoracic Society (Adana, Turkey) Boehringer Ingelheim (Adana, Turkey) Pfizer (Adana, Turkey) AstraZeneca (Salzburg, Austria) Altana (Salzburg, Austria) Boehringer Ingelheim (Salzburg, Austria) GlaxoSmithKline (Salzburg, Austria) Merck Sharpe & Dohme (Salzburg, Austria) Novartis (Salzburg, Austria) Salzburger Gebietskrankenkasse (Salzburg, Austria) Salzburg local government (Salzburg, Austria) Research for International Tobacco Control (Cape Town, South Africa) International Development Research Centre (Cape Town, South Africa) South African Medical Research Council (Cape Town, South Africa) South African Thoracic Society GlaxoSmithKline Pulmonary Research Fellowship (Cape Town, South Africa) University of Cape Town Lung Institute (Cape Town, South Africa) Landspitali-University Hospital-Scientific Fund (Reykjavik, Iceland) GlaxoSmithKline Iceland (Reykjavik, Iceland) AstraZeneca Iceland (Reykjavik, Iceland) GlaxoSmithKline Pharmaceuticals (Krakow, Poland) Polpharma (Krakow, Poland) Ivax Pharma Poland (Krakow, Poland) AstraZeneca Pharma Poland (Krakow, Poland) ZF Altana Pharma (Krakow, Poland) Pliva Krakow (Krakow, Poland) Adamed (Krakow, Poland) Novartis Poland (Krakow, Poland) Linde Gaz Polska (Krakow, Poland) Lek Polska (Krakow, Poland) Tarchominskie Zaklady Farmaceutyczne Polfa (Krakow, Poland) Starostwo Proszowice (Krakow, Poland) Skanska (Krakow, Poland) Zasada (Krakow, Poland) Agencja Mienia Wojskowego w Krakowie (Krakow, Poland) Telekomunikacja Polska (Krakow, Poland) Biernacki (Krakow, Poland) Biogran (Krakow, Poland) Amplus Bucki (Krakow, Poland) Skrzydlewski (Krakow, Poland) Sotwin (Krakow, Poland) Agroplon (Krakow, Poland) Boehringer Ingelheim (Hannover, Germany) Pfizer Germany (Hannover, Germany) Norwegian Ministry of Health's Foundation for Clinical Research (Bergen, Norway) Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway) AstraZeneca (Vancouver, Canada) Boehringer Ingelheim (Vancouver, Canada) Pfizer (Vancouver, Canada) GlaxoSmithKline (Vancouver, Canada) Marty Driesler Cancer Project (Lexington, KY) Altana (Manila, Philippines) Boehringer Ingelheim (Phil) (Manila, Philippines) GlaxoSmithKline (Manila, Philippines) Pfizer (Manila, Philippines) Philippine College of Chest Physicians (Manila, Philippines) Philippine College of Physicians (Manila, Philippines) United Laboratories (Phil) (Manila, Philippines) Air Liquide Healthcare P/L (Sydney, Australia) AstraZeneca P/L (Sydney, Australia) Boehringer Ingelheim P/L (Sydney, Australia) GlaxoSmithKline Australia P/L (Sydney, Australia) Pfizer Australia P/L (Sydney, Australia) Department of Health Policy Research Programme (London, United Kingdom) Clement Clarke International (London, United Kingdom) Boehringer Ingelheim (Lisbon, Portugal) Pfizer (Lisbon, Portugal) SwedishHeart and Lung Foundation (Uppsala, Sweden) Swedish Association Against Heart and Lung Diseases (Uppsala, Sweden) GlaxoSmithKline (Uppsala, Sweden) GlaxoSmithKline (Tartu, Estonia) AstraZeneca (Tartu, Estonia) Eesti Teadusfond (Estonian Science Foundation) (Tartu, Estonia) AstraZeneca (Maastricht, The Netherlands) CIRO HORN (Maastricht, The Netherlands) Sher-i-Kashmir Institute of Medical Sciences (Srinagar, India) Foundation for Environmental Medicine (Mumbai, India) Volkart Foundation (Mumbai, India) Boehringer Ingelheim (Sousse, Tunisia) Philippines College of Physicians (Nampicuan, Philippines) Philippines College of Chest Physicians (Nampicuan, Philippines) AstraZeneca (Nampicuan, Philippines) Boehringer Ingelheim (Nampicuan, Philippines) GlaxoSmithKline (Nampicuan, Philippines) Orient Euro Pharma (Nampicuan, Philippines) Otsuka Pharma (Nampicuan, Philippines) United Laboratories Philippines (Nampicuan, Philippines) National Heart and Lung Institute (Pune, India) Imperial College, London (Pune, India) Wellcome Trust (Ile-Ife, Nigeria) National Population Commission, Ile-Ife (Ile-Ife, Nigeria) Osun State, Nigeria (Ile-Ife, Nigeria) Kasturba Hospital (Mumbai, India

Overdiagnosis of COPD in subjects with unobstructed spirometry

Background: There are several reports on the 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.info:eu-repo/semantics/publishedVersio

COPD: should diagnosis match physiology?

We are very grateful to Dr. Vanfleteren and colleagues for commenting on our data regarding overdiagnosed COPD2 and for putting this evidence into the framework of the current understanding of the disease. Based on the data presented on overdiagnosis, and on prior Burden of Obstructive Lung Disease (BOLD) observations on underdiagnosis,3 we truly believe that our worldwide community of pulmonary specialists could do much better in caring for this extremely prevalent and devastating disease. Overall, our data indicate that for one patient with a “matched” COPD diagnosis (ie, the presence of postbronchodilator airways obstruction and a positive recall of such a diagnosis), there is always another “mismatched,” false-positive patient with COPD. This patient possibly experiences all the untoward consequences, such as receiving expensive and possibly harmful medication, and missing chances for treatment of cardiac disease or asthma. On the contrary, for each “known” patient with COPD who has a poorly reversible airway obstruction, there are four to five other patients out there with yet undetected airways obstruction. Again, we are missing opportunities in these patients for smoking intervention, symptom relief, and prolongation of their lives.info:eu-repo/semantics/publishedVersio