Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more
Open Access
- 1 November 2011
- journal article
- Published by Taylor & Francis Ltd in International Journal of Chronic Obstructive Pulmonary Disease
- Vol. 6, 597-603
- https://doi.org/10.2147/COPD.S25955
Abstract
Aims: To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD) in primary care and to examine how spirometry findings fit with general practitioners’ (GPs) diagnoses. Methods: Patients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009–2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared. Results: Among 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P < 0.001). The κ agreement between last clinical diagnosis of COPD and COPD based on spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9%) than in patients diagnosed with COPD only (6.8%, P = 0.003). Conclusion: The ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found.Keywords
This publication has 27 references indexed in Scilit:
- Oral corticosteroids for asthma or COPD were dispensed to 2.6% of Norwegians aged 7 years or over in 2004-5Primary Care Respiratory Journal, 2011
- Spirometri i allmennpraksis i Nord-NorgeTidsskrift for Den norske legeforening, 2010
- Prevalence and predictors of undiagnosed chronic obstructive pulmonary disease in a Norwegian adult general populationThe Clinical Respiratory Journal, 2009
- Prevalence of COPD in primary care: no room for complacencyFamily Practice, 2008
- [Utilization of diagnostic tools and health care services for obstructive lung disease].2008
- Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary DiseaseAmerican Journal of Respiratory and Critical Care Medicine, 2007
- Global burden of COPD: risk factors, prevalence, and future trendsThe Lancet, 2007
- International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence studyThe Lancet, 2007
- Prevalence estimates of asthma or COPD from a health interview survey and from general practitioner registration: what's the difference?European Journal of Public Health, 2005
- Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III dataEuropean Respiratory Journal, 2003