- The Burden of Obstructive Lung Disease (BOLD) study from 20 countries finds that around 62% of COPD cases are overdiagnosed (as defined by postbronchodilator unobstructed spirometry).
Why this matters
- A previous study by BOLD, published in 2013, found the opposite problem: 81% of cases were undiagnosed.
- Now, overdiagnosis is the problem, as is overtreatment, which exposes nonobstructed patients to possible adverse events with respiratory medicine.
- Population-based cohort (n=16,177) in 20 countries by the BOLD study.
- Funding: Wellcome Trust; Boehringer Ingelheim China; Merck & Co., Inc., Kenilworth, NJ, USA; others.
- 5.7% of cohort reported a previous medical diagnosis of COPD, but:
- 61.9% of them were overdiagnosed (unobstructed postbronchodilator spirometry: FEV1/FVC>lower limit of normal).
- Using the more widely used fixed-ratio criterion (unobstructed postbronchodilator spirometry: FEV1/FVC
- Overdiagnosis occurred more frequently in high-income countries (4.9% prevalence) vs 1.9% prevalence in low- to middle-income countries.
- Overdiagnosis occurred more frequently among these groups (all Ps<.001 in multivariate analysis>
- Women: OR, 1.61.
- Higher education: OR, 1.06.
- Former smokers: OR, 1.67.
- Current smokers: OR, 1.54.
- Those with wheeze: OR, 2.52.
- Those with cough: OR, 1.64.
- Those with phlegm: OR, 1.52.
- Co-occurring asthma: OR, 4.04.
- Co-occurring heart disease: OR, 1.71.
- Observational design.