Underdiagnosis of COPD in primary care

January 01, 0001

Underdiagnosis of COPD in primary care

These Canadian researchers examined the prevalence of COPD among at risk primary care patients. They also examined whether COPD had been diagnosed. They recruited patients 40 years old or older who had a smoking history of at least 20 pack-years. Participants symptoms were assessed and postbronchodilator spirometry was performed. COPD was defined as a ratio of forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) of less than 0.7 and an FEV1 of less than 80% predicted.

The researchers found: "Of the 1459 patients who met the study criteria, 1003 (68.7%) completed spirometry testing. Of these, 208 were found to have COPD, for a prevalence of 20.7%. Of the 205 participants with COPD who completed the interview about respiratory symptoms before spirometry, only 67 (32.7%) were aware of their diagnosis before the study. Compared with patients in whom COPD had been correctly diagnosed before the study, those in whom COPD had been over-diagnosed or undiagnosed were similar in terms of age, sex, current smoking status and number of visits to a primary care practitioner because of a respiratory problem."

The researchers concluded: "Among adult patients visiting a primary care practitioner, as many as one in five with known risk factors met spirometric criteria for COPD. Underdiagnosis of COPD was frequent, which suggests a need for greater screening of at-risk individuals. Knowledge of the prevalence of COPD will help plan strategies for disease management."

This study reinforces the importance screening at risk patients for COPD.

For the full abstract, click here.

Canadian Medical Association Journal 182(7):673, 20 April 2010
© 2010 Canadian Medical Association or its licensors
Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. Kylie Hill, Roger S. Goldstein, Gordon H. Guyatt, et al. Correspondence to Roger S. Goldstein: [email protected]

Category: R. Respiratory. Keywords: COPD, smoking, screening, spirometry, prevalence, epidemiological study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 11 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.