Abstract
Aim
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.
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Walters J coordinated data collection and analysis, wrote first draft of paper, prepared manuscript for publication; Walters E and Wood-Baker R supervised data collection, contributed to revisions of paper and writing discussion; Nelson M and Robinson A contributed to revisions of paper and writing discussion, Scott J and Turner P read and contributed to revisions of paper.
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The authors declare that they have no conflicts of interest in relation to this article.
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Walters, J., Walters, E., Nelson, M. et al. Factors associated with misdiagnosis of COPD in primary care. Prim Care Respir J 20, 396–402 (2011). https://doi.org/10.4104/pcrj.2011.00039
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DOI: https://doi.org/10.4104/pcrj.2011.00039
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