[Over-diagnosis of chronic obstructive pulmonary disease in Primary Care. Prevalence and determining factors]

Abstract

Introduction: COPD under-diagnosis is common in Primary Health Care medicine, due to the low use of spirometry, but there is less information about over-diagnosis of the disease in patients that have a clinical diagnosis of COPD.

Objective: The main objective of the study was to investigate the prevalence of COPD over-diagnosis in Primary Care medicine. Secondary objectives were to determine the factors associated with an incorrect clinical diagnosis of COPD and to analyse whether the pharmacological treatment is different for patients with correct or incorrect diagnosis.

Method: A prospective, observational, cross-sectional study was conducted using the spirometry results of 206 patients with a clinical diagnosis of COPD, with no prior lung function testing, and who were treated with inhaled therapy. Characteristics and treatment of patients with a correct or incorrect COPD diagnosis were compared.

Results: The prevalence of COPD over-diagnosis was 42.7% in the study population. Factors associated with an incorrect diagnosis were female sex (P<.0001), obesity (P=.009), absence of smoking history (P<.0001), lower age (P=.001), and less severe dyspnoea (P=.001). Long-acting muscarinic agents were more frequently prescribed to patients with a correct COPD diagnosis. There were no other differences regarding inhaled therapies between both groups.

Conclusions: Over-diagnosis is a frequent phenomenon in patients with a clinical diagnosis of COPD managed in Primary Care medicine. There are different features between patients with a correct and incorrect diagnosis. Spirometry is an essential tool to reduce COPD over-diagnosis.

Keywords: Atención primaria; Diagnosis; Diagnóstico; Enfermedad pulmonar obstructiva crónica; Espirometría; Primary health care; Pulmonary disease, chronic obstructive; Spirometry.