Lea Sator1, Andreas Horner2, Michael Studnicka1, Bernd Lamprecht3, Bernhard Kaiser4, Mary Ann McBurnie5, A Sonia Buist6, Luisa Gnatiuc7, David M Mannino8, Christer Janson9, Eric D Bateman10, Peter Burney7. 1. Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria. 2. Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria. Electronic address: andreas.horner@kepleruniklinikum.at. 3. Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria. 4. Department of Pulmonology, Kepler University Hospital, Linz, Austria. 5. Center for Health Research, Kaiser Permanente Northwest, Portland, OR. 6. Oregon Health and Science University, Portland, OR. 7. Respiratory Epidemiology and Public Health Group, Imperial College, London, London, United Kingdom. 8. Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY. 9. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 10. Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Abstract
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.
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.
Authors: Arthur F Gelb; Alfred Yamamoto; Eric K Verbeken; James C Hogg; Donald P Tashkin; Diem N T Tran; Roxanna M Moridzadeh; Christine Fraser; Mark J Schein; Marc Decramer; Eric F Glassy; Jay A Nadel Journal: Chronic Obstr Pulm Dis Date: 2021-01
Authors: Jerry S Zifodya; Matthew Triplette; Shahida Shahrir; Engi F Attia; Kathleen M Akgun; Grant W Soo Hoo; Maria C Rodriguez-Barradas; Cherry Wongtrakool; Laurence Huang; Kristina Crothers Journal: Medicine (Baltimore) Date: 2021-09-17 Impact factor: 1.889
Authors: Andreas Horner; Otto C Burghuber; Sylvia Hartl; Michael Studnicka; Monika Merkle; Horst Olschewski; Bernhard Kaiser; Eva Maria Wallner; Bernd Lamprecht Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-07-12