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 | |
| 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
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In: Chest, Vol. 156, No. 2, 08.2019, p. 277-288.
Research output: Contribution to journal › Article › Academic › peer-review
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 Research Group
N1 - Funding Information: Author contributions: L. S. and A. H. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse events. L. S. A. H. M. S. B. L. B. K. A. S. B. and P. B. contributed to the study conception and design, data analysis and interpretation, and final approval of the manuscript. L. S. A. H. M. S. B. L. and P. B. contributed to drafting the manuscript. M. A. McB. L. G. D. M. M. C. J. and E. D. B. contributed to the data interpretation, critical revision of the manuscript for important intellectual content, and final approval of the manuscript. Financial/nonfinancial disclosures: M. S. has received grant money from Boehringer Ingelheim and served as a consultant to AstraZeneca, Eli Lilly, Boehringer Ingelheim, Menarini, Chiesi, GSK, and Takeda. D. M. M. is now a full-time employee of GlaxoSmithKline. None declared (L. S. A. H. M. S. B. L. B. K. M. A. McB. A. S. B. L. G. C. J. E. D. B. and P. B.). Role of sponsors: The sponsors played no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. ?BOLD Collaborative Research Group Collaborators: Research teams at centers: NanShan Zhong (principal investigator [PI]), Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jingping Zheng, and Yumin Zhou (Guangzhou Institute of Respiratory Diseases, Guangzhou Medical College, Guangzhou, China); Ali Kocaba? (PI), Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, and Turgay Unalan (Department of Chest Diseases, Cukurova University School of Medicine, Adana, Turkey); Michael Studnicka (PI), Torkil Dawes, Bernd Lamprecht, and Lea Sator (Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg Austria); Eric Bateman (PI), Anamika Jithoo (PI), Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, and Janita Storbeck (University of Cape Town Lung Institute, Cape Town, South Africa); Thorarinn Gislason (PI), Bryndis Benedikdtsdottir, Kristin J?rundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, and Gunnar Gundmundsson (Department of Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland); Ewa Nizankowska-Mogilnicka (PI), Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, and Magda Twardowska (Division of Pulmonary Diseases, Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland); Tobias Welte (PI), Isabelle Bodemann, Henning Geldmacher, and Alexandra Schweda-Linow (Hannover Medical School, Hannover, Germany); Amund Gulsvik (PI), Tina Endresen, and Lene Svendsen (Department of Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway); Wan C. Tan (PI) and Wen Wang (iCapture Center for Cardiovascular and Pulmonary Research, University of British Columbia, Vancouver, BC, Canada); David M. Mannino (PI), John Cain, Rebecca Copeland, Dana Hazen, and Jennifer Methvin (University of Kentucky, Lexington, KY); Renato B. Dantes (PI), Lourdes Amarillo, Lakan U. Berratio, Lenora C. Fernandez, Norberto A. Francisco, Gerard S. Garcia, Teresita S. de Guia, Luisito F. Idolor, Sullian S. Naval, Thessa Reyes, Camilo C. Roa, Jr. Ma. Flordeliza Sanchez, and Leander P. Simpao (Philippine College of Chest Physicians, Manila, Philippines); Christine Jenkins (PI), Guy Marks (PI), Tessa Bird, Paola Espinel, Kate Hardaker, and Brett Toelle (Woolcock Institute of Medical Research, Sydney, Australia), Peter G. J. Burney (PI), Caron Amor, James Potts, Michael Tumilty, and Fiona McLean (National Heart and Lung Institute, Imperial College, London, UK); E. F. M. Wouters and G. J. Wesseling (Maastricht University Medical Center, Maastricht, the Netherlands); Cristina B?rbara (PI), F?tima Rodrigues, Herm?nia Dias, Jo?o Cardoso, Jo?o Almeida, Maria Jo?o Matos, Paula Sim?o, Moutinho Santos, and Reis Ferreira (Portuguese Society of Pneumology, Lisbon, Portugal); Christer Janson (PI), Inga Sif Olafsdottir, Katarina Nisser, Ulrike Spetz-Nystr?m, Gunilla H?gg, and Gun-Marie Lund (Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden); Rain J?gi (PI), Hendrik Laja, Katrin Ulst, Vappu Zobel, and Toomas-Julius Lill (Lung Clinic, Tartu University Hospital, Tartu, Estonia); Parvaiz A. Koul (PI), Sajjad Malik, Nissar A. Hakim, and Umar Hafiz Khan (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India); Rohini Chowgule (PI), Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, and Umesh Ghurup (Indian Institute of Environmental Medicine, Mumbai, India); Imed Harrabi (PI), Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, and Wahbi Belhaj Khalifa (Facult? de M?decine, Sousse, Tunisia); Luisito F. Idolor (PI), Teresita S. de Guia, Norberto A. Francisco, Camilo C. Roa, Fernando G. Ayuyao, Cecil Z. Tady, Daniel T. Tan, Sylvia Banal-Yang, Vincent M. Balanag, Jr. Maria Teresita N. Reyes, and Renato B. Dantes (Lung Centre of the Philippines, Philippine General Hospital, Nampicuan, Philippines); Sanjay Juvekar (PI), Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, and Vijay Gaikwad (Vadu Health and Demographic Surveillance, KEM Hospital Research Centre Pune, Pune, India); Sundeep Salvi (PI), Bill Brashier, Jyoti Londhe, and Sapna Madas (Chest Research Foundation, Pune, India); Daniel Obaseki (PI), Gregory Erhabor, Olayemi Awopeju, and Olufemi Adewole (Obafemi Awolowo University, Ile-Ife, Nigeria). Other contributions: The authors thank all study participants and researchers at all of the sites for contributing to the successful execution of this study. Additional information: The e-Table can be found in the Supplemental Materials section of the online article. Publisher Copyright: © 2019 American College of Chest Physicians
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
SN - 0012-3692
VL - 156
SP - 277
EP - 288
JO - Chest
JF - Chest
IS - 2
ER -