Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis

Lea Sator; Andreas Horner; Michael Studnicka; Bernd Lamprecht; Bernhard Kaiser; Mary Ann McBurnie; A. Sonia Buist; Luisa Gnatiuc; David M. Mannino; Christer Janson; Eric D. Bateman; Peter Burney; NanShan Zhong; Shengming Liu; Jiachun Lu; Pixin Ran; Dali Wang; Jingping Zheng; Yumin Zhou; Ali Kocabas; Attila Hancioglu; Ismail Hanta; Sedat Kuleci; Ahmet Sinan Turkyilmaz; Sema Umut; Turgay Unalan; Torkil Dawes; Eric Bateman; Anamika Jithoo; Desiree Adams; Edward Barnes; Jasper Freeman; Anton Hayes; Sipho Hlengwa; Christine Johannisen; Mariana Koopman; Innocentia Louw; Ina Ludick; Alta Olckers; Johanna Ryck; Janita Storbeck; Thorarinn Gislason; Bryndis Benedikdtsdottir; Kristin Jorundsdottir; Lovisa Gudmundsdottir; Sigrun Gudmundsdottir; Gunnar Gundmundsson; Ewa Nizankowska-Mogilnicka; E. F. M. Wouters; G. J. Wesseling; BOLD Collaborative Res Grp

doi:10.1016/j.chest.2019.01.015

Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis

Lea Sator, Andreas Horner^*, Michael Studnicka, Bernd Lamprecht, Bernhard Kaiser, Mary Ann McBurnie, A. Sonia Buist, Luisa Gnatiuc, David M. Mannino, Christer Janson, Eric D. Bateman, Peter Burney, NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jingping Zheng, Yumin Zhou, Ali KocabasAttila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Torkil Dawes, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jorundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gundmundsson, Ewa Nizankowska-Mogilnicka, E. F. M. Wouters, G. J. Wesseling, BOLD Collaborative Res Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

42 Citations (Web of Science)

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.

Original language	English
Pages (from-to)	277-288
Number of pages	12
Journal	Chest
Volume	156
Issue number	2
DOIs	https://doi.org/10.1016/j.chest.2019.01.015
Publication status	Published - Aug 2019

Keywords

COPD
false positive diagnosis
misdiagnosis
overdiagnosis
overtreatment
OBSTRUCTIVE PULMONARY-DISEASE
PREVALENCE
QUALITY
UNDERDIAGNOSIS
DEFINITIONS
DIAGNOSIS
COUNTRIES
SEVERITY
ACCURACY
SYMPTOMS

Access to Document

10.1016/j.chest.2019.01.015

Cite this

Sator, L., Horner, A., Studnicka, M., Lamprecht, B., Kaiser, B., McBurnie, M. A., Buist, A. S., Gnatiuc, L., Mannino, D. M., Janson, C., Bateman, E. D., Burney, P., Zhong, N., Liu, S., Lu, J., Ran, P., Wang, D., Zheng, J., Zhou, Y., ... BOLD Collaborative Res Grp (2019). Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis. Chest, 156(2), 277-288. https://doi.org/10.1016/j.chest.2019.01.015

@article{6d0bb665202a409d8b9f892625b9dd57,

title = "Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis",

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, OBSTRUCTIVE PULMONARY-DISEASE, PREVALENCE, QUALITY, UNDERDIAGNOSIS, DEFINITIONS, DIAGNOSIS, COUNTRIES, SEVERITY, ACCURACY, SYMPTOMS",

author = "Lea Sator and Andreas Horner and Michael Studnicka and Bernd Lamprecht and Bernhard Kaiser and McBurnie, {Mary Ann} and Buist, {A. Sonia} and Luisa Gnatiuc and Mannino, {David M.} and Christer Janson and Bateman, {Eric D.} and Peter Burney and NanShan Zhong and Shengming Liu and Jiachun Lu and Pixin Ran and Dali Wang and Jingping Zheng and Yumin Zhou and Ali Kocabas and Attila Hancioglu and Ismail Hanta and Sedat Kuleci and Turkyilmaz, {Ahmet Sinan} and Sema Umut and Turgay Unalan and Torkil Dawes and Eric Bateman and Anamika Jithoo and Desiree Adams and Edward Barnes and Jasper Freeman and Anton Hayes and Sipho Hlengwa and Christine Johannisen and Mariana Koopman and Innocentia Louw and Ina Ludick and Alta Olckers and Johanna Ryck and Janita Storbeck and Thorarinn Gislason and Bryndis Benedikdtsdottir and Kristin Jorundsdottir and Lovisa Gudmundsdottir and Sigrun Gudmundsdottir and Gunnar Gundmundsson and Ewa Nizankowska-Mogilnicka and Wouters, {E. F. M.} and Wesseling, {G. J.} and {BOLD Collaborative Res Grp}",

year = "2019",

month = aug,

doi = "10.1016/j.chest.2019.01.015",

language = "English",

volume = "156",

pages = "277--288",

journal = "Chest",

issn = "0012-3692",

publisher = "Elsevier",

number = "2",

}

Sator, L, Horner, A, Studnicka, M, Lamprecht, B, Kaiser, B, McBurnie, MA, Buist, AS, Gnatiuc, L, Mannino, DM, Janson, C, Bateman, ED, Burney, P, Zhong, N, Liu, S, Lu, J, Ran, P, Wang, D, Zheng, J, Zhou, Y, Kocabas, A, Hancioglu, A, Hanta, I, Kuleci, S, Turkyilmaz, AS, Umut, S, Unalan, T, Dawes, T, 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, Jorundsdottir, K, Gudmundsdottir, L, Gudmundsdottir, S, Gundmundsson, G, Nizankowska-Mogilnicka, E, Wouters, EFM , Wesseling, GJ & BOLD Collaborative Res Grp 2019, 'Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis', Chest, vol. 156, no. 2, pp. 277-288. https://doi.org/10.1016/j.chest.2019.01.015

TY - JOUR

T1 - Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis

AU - Sator, Lea

AU - Horner, Andreas

AU - Studnicka, Michael

AU - Lamprecht, Bernd

AU - Kaiser, Bernhard

AU - McBurnie, Mary Ann

AU - Buist, A. Sonia

AU - Gnatiuc, Luisa

AU - Mannino, David M.

AU - Janson, Christer

AU - Bateman, Eric D.

AU - Burney, Peter

AU - Zhong, NanShan

AU - Liu, Shengming

AU - Lu, Jiachun

AU - Ran, Pixin

AU - Wang, Dali

AU - Zheng, Jingping

AU - Zhou, Yumin

AU - Kocabas, Ali

AU - Hancioglu, Attila

AU - Hanta, Ismail

AU - Kuleci, Sedat

AU - Turkyilmaz, Ahmet Sinan

AU - Umut, Sema

AU - Unalan, Turgay

AU - Dawes, Torkil

AU - Bateman, Eric

AU - Jithoo, Anamika

AU - Adams, Desiree

AU - Barnes, Edward

AU - Freeman, Jasper

AU - Hayes, Anton

AU - Hlengwa, Sipho

AU - Johannisen, Christine

AU - Koopman, Mariana

AU - Louw, Innocentia

AU - Ludick, Ina

AU - Olckers, Alta

AU - Ryck, Johanna

AU - Storbeck, Janita

AU - Gislason, Thorarinn

AU - Benedikdtsdottir, Bryndis

AU - Jorundsdottir, Kristin

AU - Gudmundsdottir, Lovisa

AU - Gudmundsdottir, Sigrun

AU - Gundmundsson, Gunnar

AU - Nizankowska-Mogilnicka, Ewa

AU - Wouters, E. F. M.

AU - Wesseling, G. J.

AU - BOLD Collaborative Res Grp

PY - 2019/8

Y1 - 2019/8

N2 - 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.

AB - 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.

KW - COPD

KW - false positive diagnosis

KW - misdiagnosis

KW - overdiagnosis

KW - overtreatment

KW - OBSTRUCTIVE PULMONARY-DISEASE

KW - PREVALENCE

KW - QUALITY

KW - UNDERDIAGNOSIS

KW - DEFINITIONS

KW - DIAGNOSIS

KW - COUNTRIES

KW - SEVERITY

KW - ACCURACY

KW - SYMPTOMS

U2 - 10.1016/j.chest.2019.01.015

DO - 10.1016/j.chest.2019.01.015

M3 - Article

C2 - 30711480

VL - 156

SP - 277

EP - 288

JO - Chest

JF - Chest

SN - 0012-3692

IS - 2

ER -