Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care
Top Cited Papers
- 6 April 2010
- journal article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 182 (7) , 673-678
- https://doi.org/10.1503/cmaj.091784
Abstract
Background: People with known risk factors for chronic obstructive pulmonary disease (COPD) are important targets for screening and early intervention. We sought to measure the prevalence of COPD among such individuals visiting a primary care practitioner for any reason. We also evaluated the accuracy of prior diagnosis or nondiagnosis of COPD and identified associated clinical characteristics. Methods: We recruited patients from three primary care sites who were 40 years or older and had a smoking history of at least 20 pack-years. Participants were asked about respiratory symptoms and underwent postbronchodilator spirometry. 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. Results: 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% (95% confidence interval 18.3%–23.4%). 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. Interpretation: 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.Keywords
This publication has 32 references indexed in Scilit:
- Effect of primary-care spirometry on the diagnosis and management of COPDEuropean Respiratory Journal, 2006
- Standardisation of spirometryEuropean Respiratory Journal, 2005
- Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care.2004
- Do GOLD stages of COPD severity really correspond to differences in health status?European Respiratory Journal, 2003
- Obstructive Lung Disease and Low Lung Function in Adults in the United StatesArchives of internal medicine (1960), 2000
- Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary diseaseThorax, 1999
- Spirometric Reference Values from a Sample of the General U.S. PopulationAmerican Journal of Respiratory and Critical Care Medicine, 1999
- BTS guidelines for the management of chronic obstructive pulmonary disease. The COPD Guidelines Group of the Standards of Care Committee of the BTS.1997
- Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease StudyPublished by Elsevier ,1997
- The natural history of chronic airflow obstruction.BMJ, 1977