TY - JOUR
T1 - Overdiagnosis of COPD in Subjects With Unobstructed Spirometry
T2 - A BOLD Analysis
AU - BOLD Collaborative Research Group
AU - Sator, Lea
AU - Horner, Andreas
AU - Studnicka, Michael
AU - Lamprecht, Bernd
AU - Kaiser, Bernhard
AU - McBurnie, Mary Ann
AU - Buist, A. Sonia
AU - Gnatiuc, Luisa
AU - Mannino, David M.
AU - Janson, Christer
AU - Bateman, Eric D.
AU - Burney, Peter
AU - Zhong, Nan Shan
AU - Liu, Shengming
AU - Lu, Jiachun
AU - Ran, Pixin
AU - Wang, Dali
AU - Zheng, Jingping
AU - Zhou, Yumin
AU - Kocabaş, Ali
AU - Hancioglu, Attila
AU - Hanta, Ismail
AU - Kuleci, Sedat
AU - Turkyilmaz, Ahmet Sinan
AU - Umut, Sema
AU - Unalan, Turgay
AU - Dawes, Torkil
AU - Bateman, Eric
AU - Jithoo, Anamika
AU - Adams, Desiree
AU - Barnes, Edward
AU - Freeman, Jasper
AU - Hayes, Anton
AU - Hlengwa, Sipho
AU - Johannisen, Christine
AU - Koopman, Mariana
AU - Louw, Innocentia
AU - Ludick, Ina
AU - Olckers, Alta
AU - Ryck, Johanna
AU - Storbeck, Janita
AU - Gislason, Thorarinn
AU - Benedikdtsdottir, Bryndis
AU - Jörundsdottir, Kristin
AU - Gudmundsdottir, Lovisa
AU - Gudmundsdottir, Sigrun
AU - Gundmundsson, Gunnar
AU - Nizankowska-Mogilnicka, Ewa
AU - Frey, Jakub
AU - Harat, Rafal
N1 - Publisher Copyright:
© 2019 American College of Chest Physicians
PY - 2019/8
Y1 - 2019/8
N2 - 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.
AB - 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.
KW - COPD
KW - false positive diagnosis
KW - misdiagnosis
KW - overdiagnosis
KW - overtreatment
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U2 - 10.1016/j.chest.2019.01.015
DO - 10.1016/j.chest.2019.01.015
M3 - Article
C2 - 30711480
AN - SCOPUS:85064324384
SN - 0012-3692
VL - 156
SP - 277
EP - 288
JO - CHEST
JF - CHEST
IS - 2
ER -