AIMS: To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care. METHODS: A cross-sectional study was performed in 31 (19%) practices in one Australian state. 341 patients with COPD (database diagnosis or current use of tiotropium plus GP confirmation) completed spirometry and questionnaires. Predictors of misclassification were investigated with multi-level mixed-effects logistic regression allowing for clustering by practice. RESULTS: Spirometric confirmation of COPD (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7) was not present in 107 (31%) patients; 60 (56%) had normal lung function, seven (7%) had scalloped flow-volume curves and FEV1 <80% predicted, 40 (37%) had restriction (FVC <80% predicted). Among 107 misclassified patients the bronchodilators used were tiotropium in 26% and long-acting β2-agonists in 22%. The likelihood of misclassification increased with overweight/obesity (odds ratio (OR) 2.66; 95% CI 1.50 to 4.70) and self-reported allergic rhinitis/hay fever (OR 1.72; 95% CI 1.13 to 2.64) after adjustment for age, gender, and smoking. CONCLUSIONS: Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometry is essential to avoid inappropriate management.
AIMS: To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care. METHODS: A cross-sectional study was performed in 31 (19%) practices in one Australian state. 341 patients with COPD (database diagnosis or current use of tiotropium plus GP confirmation) completed spirometry and questionnaires. Predictors of misclassification were investigated with multi-level mixed-effects logistic regression allowing for clustering by practice. RESULTS: Spirometric confirmation of COPD (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7) was not present in 107 (31%) patients; 60 (56%) had normal lung function, seven (7%) had scalloped flow-volume curves and FEV1 <80% predicted, 40 (37%) had restriction (FVC <80% predicted). Among 107 misclassified patients the bronchodilators used were tiotropium in 26% and long-acting β2-agonists in 22%. The likelihood of misclassification increased with overweight/obesity (odds ratio (OR) 2.66; 95% CI 1.50 to 4.70) and self-reported allergic rhinitis/hay fever (OR 1.72; 95% CI 1.13 to 2.64) after adjustment for age, gender, and smoking. CONCLUSIONS: Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometry is essential to avoid inappropriate management.
Authors: Kristen S Willard; Jamie B Sullivan; Byron M Thomashow; Catherine S Jones; Leonard Fromer; Barbara P Yawn; Alpesh Amin; Jean M Rommes; Rhonda Rotert Journal: Chronic Obstr Pulm Dis Date: 2016-10-06
Authors: Moshe Zutler; Jonathan P Singer; Theodore A Omachi; Mark Eisner; Carlos Iribarren; Patricia Katz; Paul D Blanc Journal: Prim Care Respir J Date: 2012-06
Authors: Valentin Prieto-Centurion; Andrew J Rolle; David H Au; Shannon S Carson; Ashley G Henderson; Todd A Lee; Peter K Lindenauer; Mary A McBurnie; Richard A Mularski; Edward T Naureckas; William M Vollmer; Binoy J Joese; Jerry A Krishnan Journal: Am J Respir Crit Care Med Date: 2014-11-01 Impact factor: 21.405