Factors associated with misdiagnosis of COPD in primary care

Primary Care Respiratory Journal : Journal of the General Practice Airways Group
J A WaltersR Wood-Baker

Abstract

To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care. 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. 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. Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometr...Continue Reading

References

Sep 1, 1991·Respiratory Medicine·P W JonesC M Baveystock
Jun 1, 1983·Acta Psychiatrica Scandinavica·A S Zigmond, R P Snaith
Jan 5, 1999·American Journal of Respiratory and Critical Care Medicine·J HankinsonK B Fedan
Dec 2, 1999·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·E R AndersonE A Weymuller
Feb 7, 2001·Thorax·R HubbardS Range
Jun 13, 2001·The European Respiratory Journal·Peter MontnémeryC G Persson
Jul 2, 2002·Archives of Internal Medicine·Don D SinS F Paul Man
Mar 14, 2003·The Medical Journal of Australia·David K McKenzieThoracic Society of Australia and New Zealand
Feb 9, 2005·Current Opinion in Pulmonary Medicine·T L Petty
Jun 9, 2005·Respiration; International Review of Thoracic Diseases·Lazaros SichletidisT Konstantinidis
Aug 2, 2005·The European Respiratory Journal·M R MillerATS/ERS Task Force
Feb 3, 2006·The European Respiratory Journal·Alan D LopezS Buist
Apr 26, 2006·Respirology : Official Journal of the Asian Pacific Society of Respirology·D P JohnsRichard Wood-Baker
Apr 26, 2006·Respirology : Official Journal of the Asian Pacific Society of Respirology·J A WaltersD P Johns
Jul 1, 2006·Treatments in Respiratory Medicine·Vijay N JoishRiad Dirani
Jul 15, 2006·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Heidi WolfendenMartyn R Partridge
Sep 19, 2006·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Timothy L FrankPeter I Frank
Jan 20, 2007·Journal of Applied Physiology·Dror OfirDenis E O'Donnell
Feb 14, 2007·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·David G TinkelmanRonald J Halbert
Mar 23, 2007·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Lazaros SichletidisDimitros Patakas
Mar 12, 2008·Clinical Physiology and Functional Imaging·Ulf NihlénLennart Greiff
Apr 19, 2008·American Journal of Respiratory and Critical Care Medicine·Tony G BabbBelinda Schwartz
Jun 19, 2008·Journal of Clinical Nursing·Andrew RobinsonEugene Haydn Walters
Nov 19, 2008·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Shawn D AaronCanadian Respiratory Clinical Research Consortium
Nov 21, 2008·Thorax·F M E FranssenA M W J Schols
Apr 8, 2010·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Kylie HillMatthew B Stanbrook

Citations

May 3, 2013·International Journal of Chronic Obstructive Pulmonary Disease·Daniel E Murphy, Ralph J Panos
Dec 19, 2013·International Journal of Chronic Obstructive Pulmonary Disease·Christian GhattasMagdi H Awad
May 8, 2014·International Journal of Family Medicine·Nathalie SaadJean Bourbeau
Sep 6, 2014·American Journal of Respiratory and Critical Care Medicine·Valentin Prieto-CenturionCONCERT Consortium
Aug 12, 2014·The Clinical Respiratory Journal·Maoyun WangChangguo Wang
Feb 24, 2015·Respirology : Official Journal of the Asian Pacific Society of Respirology·Nathania A J B CooksleyGraeme P Maguire
Jun 2, 2015·NPJ Primary Care Respiratory Medicine·Nancy K LeidyHigh-Risk-COPD Screening Study Group
Jan 31, 2014·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Mark StrongJo Cooke
Feb 27, 2014·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Anthony J StanleyNicholas A Zwar
Oct 20, 2011·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Mike Thomas, D Robin Taylor
Apr 29, 2014·Atencion primaria·M Antònia Llaugeren nombre del grupo de trabajo de espirometría del Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR)
Jun 19, 2012·Atencion primaria·José Miguel Berrospi MelgarejoMariano Leal Hernández
May 18, 2016·The Lancet. Respiratory Medicine·MeiLan K HanMark T Dransfield
Feb 3, 2016·American Journal of Respiratory and Critical Care Medicine·Laura E LabontéCanCOLD Collaborative Research Group
Jul 28, 2016·Scientific Reports·Qun ZhangJianming Wang
Feb 5, 2015·Revista da Associação Médica Brasileira·Bruno Piassi de São JoséRicardo de Amorim Corrêa
Sep 21, 2017·Postgraduate Medicine·Jorge E Lascano, Michael A Campos
Nov 23, 2017·Canadian Pharmacists Journal : CPJ = Revue Des Pharmaciens Du Canada : RPC·Alan KaplanKristine Petrasko
Dec 19, 2018·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Marie FiskC Michael Roberts
Mar 7, 2019·Breathe·Terence HoOm P Kurmi
Jun 25, 2016·The European Respiratory Journal·Andrea GershonTeresa To
Jun 24, 2017·The European Respiratory Journal·Shamil HaroonRachel E Jordan
Mar 29, 2012·Primary Care Respiratory Journal : Journal of the General Practice Airways Group·Moshe ZutlerPaul D Blanc
Dec 7, 2017·COPD·S ZewariY Heijdra
Oct 3, 2012·The Medical Journal of Australia·Mark R Nelson
Feb 20, 2013·The Medical Journal of Australia·Christine F McDonald, Nicholas Glasgow
Feb 20, 2013·The Medical Journal of Australia·Brett G ToelleGuy B Marks
Aug 13, 2014·Expert Review of Respiratory Medicine·Kaosia NowrinEugene Haydn Walters
Jul 7, 2018·American Journal of Respiratory and Critical Care Medicine·Nermin DiabShawn D Aaron
Aug 17, 2019·NPJ Primary Care Respiratory Medicine·Lynn JosephsMike Thomas
Jan 21, 2012·Current Opinion in Pulmonary Medicine·David C L LamMary S M Ip
Jan 31, 2021·NPJ Digital Medicine·Isabella Friis Jørgensen, Søren Brunak
Mar 5, 2021·International Journal of Chronic Obstructive Pulmonary Disease·Kate PetrieMichael J Abramson
Aug 17, 2011·The Medical Journal of Australia·Nicholas A ZwarStephen F Wilson
Feb 23, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Alan KaplanPaul Mastoridis

Related Concepts

Spiriva
Broncholytic Effect
Prevalence Studies
Misdiagnosis
Forced Expiratory Volume Function
Primary Health Care
Scopolamine Derivatives
Severity of Illness Index
Spirometry
Logistic Regression

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Alzheimer's Disease: MS4A

Variants within the membrane-spanning 4-domains subfamily A (MS4A) gene cluster have recently been implicated in Alzheimer's disease in genome-wide association studies. Here is the latest research on Alzheimer's disease and MS4A.

Pediculosis pubis

Pediculosis pubis is a disease caused by a parasitic insect known as Pthirus pubis, which infests human pubic hair, as well as other areas with hair including eye lashes. Here is the latest research.

Rh Isoimmunization

Rh isoimmunization is a potentially preventable condition that occasionally is associated with significant perinatal morbidity or mortality. Discover the latest research on Rh Isoimmunization here.

Genetic Screens in iPSC-derived Brain Cells

Genetic screening is a critical tool that can be employed to define and understand gene function and interaction. This feed focuses on genetic screens conducted using induced pluripotent stem cell (iPSC)-derived brain cells. It also follows CRISPR-Cas9 approaches to generating genetic mutants as a means of understanding the effect of genetics on phenotype.

Enzyme Evolution

This feed focuses on molecular models of enzyme evolution and new approaches (such as adaptive laboratory evolution) to metabolic engineering of microorganisms. Here is the latest research.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Pharmacology of Proteinopathies

This feed focuses on the pharmacology of proteinopathies - diseases in which proteins abnormally aggregate (i.e. Alzheimer’s, Parkinson’s, etc.). Discover the latest research in this field with this feed.

Alignment-free Sequence Analysis Tools

Alignment-free sequence analyses have been applied to problems ranging from whole-genome phylogeny to the classification of protein families, identification of horizontally transferred genes, and detection of recombined sequences. Here is the latest research.