Underdiagnosis and Overdiagnosis of Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is regarded as one of the leading causes of morbidity and mortality across the world, yet its proper diagnosis remains a challenge. Community-based population studies conducted in North and South America, Europe, Australia and Asia have revealed that 10%-12% of adults ≥ age 40 have evidence of persistent airflow limitation on spirometry, but only 20-30% of these subjects have been diagnosed with COPD. These studies collectively suggest that approximately 70% of COPD worldwide is under-diagnosed. Conversely other studies have shown that between 30-60% of patients with a previous physician diagnosis of COPD do not actually have the disease and hence they have been over- diagnosed. In this review, we define under and over-diagnosis and explore the prevalence and the burden of under and over-diagnosis of COPD on both patients and on health care systems. We further describe potential solutions to reduce the incidence of under and over-diagnosis of COPD.