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Chest. 2019 Aug;156(2):277-288. doi: 10.1016/j.chest.2019.01.015. Epub 2019 Jan 31.

Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis.

Collaborators (164)

Zhong N, Liu S, Lu J, Ran P, Wang D, Zheng J, Zhou Y, Kocabaş A, Hancioglu A, Hanta I, Kuleci S, Turkyilmaz AS, Umut S, Unalan T, Studnicka M, Dawes T, Lamprecht B, Sator L, Bateman E, Jithoo A, Adams D, Barnes E, Freeman J, Hayes A, Hlengwa S, Johannisen C, Koopman M, Louw I, Ludick I, Olckers A, Ryck J, Storbeck J, Gislason T, Benedikdtsdottir B, Jörundsdottir K, Gudmundsdottir L, Gudmundsdottir S, Gundmundsson G, Nizankowska-Mogilnicka E, Frey J, Harat R, Mejza F, Nastalek P, Pajak A, Skucha W, Szczeklik A, Twardowska M, Welte T, Bodemann I, Geldmacher H, Schweda-Linow A, Gulsvik A, Endresen T, Svendsen L, Tan WC, Wang W, Mannino DM, Cain J, Copeland R, Hazen D, Methvin J, Dantes RB, Amarillo L, Berratio LU, Fernandez LC, Francisco NA, Garcia GS, de Guia TS, Idolor LF, Naval SS, Reyes T, Roa CC Jr, Sanchez MF, Simpao LP, Jenkins C, Marks G, Bird T, Espinel P, Hardaker K, Toelle B, Burney PGJ, Amor C, Potts J, Tumilty M, McLean F, Wouters EFM, Wesseling GJ, Bárbara C, Rodrigues F, Dias H, Cardoso J, Almeida J, Matos MJ, Simão P, Santos M, Ferreira R, Janson C, Olafsdottir IS, Nisser K, Spetz-Nyström U, Hägg G, Lund GM, Jõgi R, Laja H, Ulst K, Zobel V, Lill TJ, Koul PA, Malik S, Hakim NA, Khan UH, Chowgule R, Shetye V, Raphael J, Almeda R, Tawde M, Tadvi R, Katkar S, Kadam M, Dhanawade R, Ghurup U, Harrabi I, Denguezli M, Tabka Z, Daldoul H, Boukheroufa Z, Chouikha F, Khalifa WB, Idolor LF, de Guia TS, Francisco NA, Roa CC, Ayuyao FG, Tady CZ, Tan DT, Banal-Yang S, Balanag VM Jr, Reyes MTN, Dantes RB, Juvekar S, Hirve S, Sambhudas S, Chaidhary B, Tambe M, Pingale S, Umap A, Umap A, Shelar N, Devchakke S, Chaudhary S, Bondre S, Walke S, Gawhane A, Sapkal A, Argade R, Gaikwad V, Salvi S, Brashier B, Londhe J, Madas S, Obaseki D, Erhabor G, Awopeju O, Adewole O.

Author information

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.

KEYWORDS:

COPD; false positive diagnosis; misdiagnosis; overdiagnosis; overtreatment

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