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Factors associated with misdiagnosis of COPD in primary care
Citation
Walters, JA and Walters, EH and Nelson, M and Robinson, A and Scott, J and Turner, P and Wood-Baker, R, Factors associated with misdiagnosis of COPD in primary care, Primary Care Respiratory Journal, 20, (4) pp. 396-402. ISSN 1471-4418 (2011) [Refereed Article]
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Copyright Statement
Copyright 2011 PCRS-UK
DOI: doi:10.4104/pcrj.2011.00039
Abstract
Aim: To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care.
Methods: A cross-sectional study was performed in 31 (19%) practices in one Australian state. 341 patients with COPD (database
diagnosis or current use of tiotropium plus GP confirmation) completed spirometry and questionnaires. Predictors of misclassification were
investigated with multi-level mixed-effects logistic regression allowing for clustering by practice.
Results: Spirometric confirmation of COPD (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7) was not present in
107 (31%) patients; 60 (56%) had normal lung function, seven (7%) had scalloped flow-volume curves and FEV1 <80% predicted, 40
(37%) had restriction (FVC <80% predicted). Among 107 misclassified patients the bronchodilators used were tiotropium in 26% and
long-acting â2-agonists in 22%. The likelihood of misclassification increased with overweight/obesity (odds ratio (OR) 2.66; 95% CI 1.50
to 4.70) and self-reported allergic rhinitis/hay fever (OR 1.72; 95% CI 1.13 to 2.64) after adjustment for age, gender, and smoking.
Conclusions: Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic
spirometry is essential to avoid inappropriate management.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Keywords: | COPD, primary care, diagnosis, spirometry, misclassification |
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Respiratory diseases |
| Objective Division: | Health |
| Objective Group: | Clinical health |
| Objective Field: | Clinical health not elsewhere classified |
| UTAS Author: | Walters, JA (Dr Julia Walters) |
| UTAS Author: | Walters, EH (Professor Haydn Walters) |
| UTAS Author: | Nelson, M (Professor Mark Nelson) |
| UTAS Author: | Robinson, A (Professor Andrew Robinson) |
| UTAS Author: | Scott, J (Professor Jenn Scott) |
| UTAS Author: | Turner, P (Associate Professor Paul Turner) |
| UTAS Author: | Wood-Baker, R (Professor Richard Wood-Baker) |
| ID Code: | 71961 |
| Year Published: | 2011 |
| Web of Science® Times Cited: | 73 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2011-08-16 |
| Last Modified: | 2012-06-15 |
| Downloads: | 5 View Download Statistics |
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