COPD underdiagnosis and misdiagnosis in a high-risk primary care population in four Latin American countries. A key to enhance disease diagnosis : The PUMA study

Background Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay. Objectives To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting. Methods COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/ forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed. Results 1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients 69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I-II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry. Conclusions COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting. © 2016 Casas Herrera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

COPD underdiagnosis and misdiagnosis in a high-risk primary care population in four Latin American countries. A key to enhance disease diagnosis : The PUMA study

Background Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay. Objectives To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting. Methods COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/ forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed. Results 1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients 69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I-II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry. Conclusions COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting. © 2016 Casas Herrera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

Background To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD. Methods Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated. Results 734 patients (59.6% male, mean age 69.5 years, mean FEV1 50% predicted normal) were recruited. The most frequent symptoms during the day were dyspnea (75% of patients, of which 94% mild-moderate) and cough (72.2%, of which 93.4% mild-moderate). Highly symptomatic patients had a greater impairment in FEV1, more exacerbations and worse scores in COPD assessment test (CAT) and Body Mass Index, Obstruction, Dyspnoea and Exacerbations (BODEx) index (all p and lt; 0.001). Morning symptoms were more frequent than night-time symptoms, particularly cough and dyspnoea (morning: 50.1% and 45.7%; night-time: 33.2% and 24.4%, respectively), and mostly rated as mild or moderate. Patients with morning or night-time symptoms presented with worse severity of daytime symptoms. There was a strong correlation between intensity of daytime with morning or night-time symptoms, as well as with CAT score (r = 0.715; p and lt; 0.001), but a weak correlation with FEV1 (r = ?0.205; p and lt; 0.001). Conclusion Morning symptoms were more frequent than night-time symptoms, and having either morning and/or night-time symptoms was associated with worse severity of daytime symptoms. Increased symptoms were strongly associated with worse quality of life and more frequent exacerbations, but weakly associated with airflow limitation. Clinical trial registration NCT02789540. © 2017 Elsevier Lt

Logistic regression models to identify factors associated to COPD underdiagnosis according to different criteria.

<p>Logistic regression models to identify factors associated to COPD underdiagnosis according to different criteria.</p

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

Background To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD. Methods Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated. Results 734 patients (59.6% male, mean age 69.5 years, mean FEV1 50% predicted normal) were recruited. The most frequent symptoms during the day were dyspnea (75% of patients, of which 94% mild-moderate) and cough (72.2%, of which 93.4% mild-moderate). Highly symptomatic patients had a greater impairment in FEV1, more exacerbations and worse scores in COPD assessment test (CAT) and Body Mass Index, Obstruction, Dyspnoea and Exacerbations (BODEx) index (all p and lt; 0.001). Morning symptoms were more frequent than night-time symptoms, particularly cough and dyspnoea (morning: 50.1% and 45.7%; night-time: 33.2% and 24.4%, respectively), and mostly rated as mild or moderate. Patients with morning or night-time symptoms presented with worse severity of daytime symptoms. There was a strong correlation between intensity of daytime with morning or night-time symptoms, as well as with CAT score (r = 0.715; p and lt; 0.001), but a weak correlation with FEV1 (r = ?0.205; p and lt; 0.001). Conclusion Morning symptoms were more frequent than night-time symptoms, and having either morning and/or night-time symptoms was associated with worse severity of daytime symptoms. Increased symptoms were strongly associated with worse quality of life and more frequent exacerbations, but weakly associated with airflow limitation. Clinical trial registration NCT02789540. © 2017 Elsevier Lt

COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

<div><p>Background</p><p>Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.</p><p>Objectives</p><p>To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.</p><p>Methods</p><p>COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed.</p><p>Results</p><p>1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV₁/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV₁/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV₁/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m²), milder airway obstruction (GOLD I–II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry.</p><p>Conclusions</p><p>COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.</p></div

Proportion of underdiagnosis among those patients with spirometric diagnosis of COPD by post-BD FEV₁/FVC <0.70, and correct prior diagnosis or misdiagnosis among those patients with previous COPD medical diagnosis.

<p>Proportion of underdiagnosis among those patients with spirometric diagnosis of COPD by post-BD FEV₁/FVC <0.70, and correct prior diagnosis or misdiagnosis among those patients with previous COPD medical diagnosis.</p

Proportion of COPD underdiagnosis according to different criteria (post-BD FEV₁/FVC <0.70 and LLN), total and by country.

<p>P-values for the comparison of underdiagnosis by Fixed ratio and the LLN criteria: Uruguay p = 0.73; Venezuela p = 0.57; Colombia p = 0.78; Argentina p = 0.42; Total p = 0.33.</p

Prevalence ratios for underdiagnosis according to type of physician visited in past year, by COPD criteria: A) post-BD FEV₁/FVC<0.70; and B) LLN.

<p>Prevalence ratios for underdiagnosis according to type of physician visited in past year, by COPD criteria: A) post-BD FEV₁/FVC<0.70; and B) LLN.</p

Sample description according to selected variables, prevalence of COPD (medical diagnosis, post-BD FEV₁/FVC <0.70 and LLN criteria) and underdiagnosis proportion of COPD (fixed ratio and LLN criteria).

<p>Sample description according to selected variables, prevalence of COPD (medical diagnosis, post-BD FEV₁/FVC <0.70 and LLN criteria) and underdiagnosis proportion of COPD (fixed ratio and LLN criteria).</p