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Factors associated with misdiagnosis of COPD in primary care


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


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 Ô2-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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