COPD: most patients diagnosed and treated for it don’t have it

  • Sator L & al.
  • Chest
  • 31 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Overdiagnosis of COPD is common.
  • Symptom-based diagnosis without spirometry risks exposing patients to unnecessary medication.
  • Authors: “Health care professionals are either not aware of COPD guidelines or do not use them for their decision-making.”

Why this matters

  • Few studies have examined overdiagnosis of COPD.
  • Postbronchodilator spirometry is mandatory diagnostic criterion for COPD but is frequently skipped.

Key results

  • Of 919 reporting COPD diagnosis, 61.9% (569) had unobstructed postbronchodilator spirometry, meaning they did not have COPD.
  • False-positive rate was 55.3% using fixed-ratio criterion (FEV1/FVC
  • Among false-positives:
    • 45.7% were using respiratory medication, most often inhaled corticosteroids.
    • 34.4% of those without asthma were using respiratory medication.
  • False-positive rates in high- vs low-income countries: 4.9% vs 1.9%.
  • Predictors of overdiagnosis included female sex, higher education, current or former smoking, respiratory symptoms, comorbid asthma, or heart disease.
  • False-negatives: 10.2%.

Study design

  • Analysis of multinational population-based cross-sectional BOLD study, 2003-2012 (n=16,177).
  • After face-to-face interview, participants underwent pre- and postbronchodilator spirometry.
  • Outcome: rate of false-positive COPD, defined as patient reporting doctor’s diagnosis of COPD, chronic bronchitis, or emphysema but lacking unobstructed postbronchodilator spirometry (FEV1/FVC
  • Funding: The Wellcome Trust; multiple industry, academic sources.

Limitations

  • Self-report might overestimate diagnosis.