Overdiagnosis of COPD in Subjects With Unobstructed Spirometry A BOLD Analysis

• Published in: Chest
• Main Authors: Sator, Lea, Horner, Andreas, Studnicka, Michael, Lamprecht, Bernd, Kaiser, Bernhard, McBurnie, Mary Ann, Buist, A. Sonia
• Other Authors: Çukurova Üniversitesi
• Format: Article in Journal/Newspaper
• Language: English
• Published: ELSEVIER 2019
• Subjects: COPD; false positive diagnosis; misdiagnosis; overdiagnosis; overtreatment; Bergen; Canada; Linde; Norway; Polska; Iceland
• Online Access: https://hdl.handle.net/20.500.12605/8951; https://doi.org/10.1016/j.chest.2019.01.015

WOS: 000478787900019 PubMed ID: 30711480 BACKGROUND: There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. METHODS: A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). RESULTS: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. CONCLUSIONS: False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication. AventisSanofi-Aventis; AstraZenecaAstraZeneca; Boehringer IngelheimBoehringer Ingelheim; Chiesi; GlaxoSmithKlineGlaxoSmithKline; MerckMerck & Company; Novartis, PfizerPfizer; Schering-PloughMerck & CompanySchering Plough Corporation; Sepracor; University of Kentucky; Wellcome TrustWellcome Trust [085790/Z/08/Z]; Boehringer Ingelheim China. (Guangzhou, China); Turkish Thoracic Society (Adana, Turkey); Boehringer Ingelheim (Adana, Turkey); Pfizer (Adana, Turkey); AstraZeneca (Salzburg, Austria); Altana (Salzburg, Austria); Boehringer Ingelheim (Salzburg, Austria); GlaxoSmithKline (Salzburg, Austria); Merck Sharpe & Dohme (Salzburg, Austria); Novartis (Salzburg, Austria); Salzburger Gebietskrankenkasse (Salzburg, Austria); Salzburg local government (Salzburg, Austria); Research for International Tobacco Control (Cape Town, South Africa); International Development Research Centre (Cape Town, South Africa); South African Medical Research Council (Cape Town, South Africa); South African Thoracic Society GlaxoSmithKline Pulmonary Research Fellowship (Cape Town, South Africa); University of Cape Town Lung Institute (Cape Town, South Africa); Landspitali-University Hospital-Scientific Fund (Reykjavik, Iceland); GlaxoSmithKline Iceland (Reykjavik, Iceland); AstraZeneca Iceland (Reykjavik, Iceland); GlaxoSmithKline Pharmaceuticals (Krakow, Poland); Polpharma (Krakow, Poland); Ivax Pharma Poland (Krakow, Poland); AstraZeneca Pharma Poland (Krakow, Poland); ZF Altana Pharma (Krakow, Poland); Pliva Krakow (Krakow, Poland); Adamed (Krakow, Poland); Novartis Poland (Krakow, Poland); Linde Gaz Polska (Krakow, Poland); Lek Polska (Krakow, Poland); Tarchominskie Zaklady Farmaceutyczne Polfa (Krakow, Poland); Starostwo Proszowice (Krakow, Poland); Skanska (Krakow, Poland); Zasada (Krakow, Poland); Agencja Mienia Wojskowego w Krakowie (Krakow, Poland); Telekomunikacja Polska (Krakow, Poland); Biernacki (Krakow, Poland); Biogran (Krakow, Poland); Amplus Bucki (Krakow, Poland); Skrzydlewski (Krakow, Poland); Sotwin (Krakow, Poland); Agroplon (Krakow, Poland); Boehringer Ingelheim (Hannover, Germany); Pfizer Germany (Hannover, Germany); Norwegian Ministry of Health's Foundation for Clinical Research (Bergen, Norway); Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway); AstraZeneca (Vancouver, Canada); Boehringer Ingelheim (Vancouver, Canada); Pfizer (Vancouver, Canada); GlaxoSmithKline (Vancouver, Canada); Marty Driesler Cancer Project (Lexington, KY); Altana (Manila, Philippines); Boehringer Ingelheim (Phil) (Manila, Philippines); GlaxoSmithKline (Manila, Philippines); Pfizer (Manila, Philippines); Philippine College of Chest Physicians (Manila, Philippines); Philippine College of Physicians (Manila, Philippines); United Laboratories (Phil) (Manila, Philippines); Air Liquide Healthcare P/L (Sydney, Australia); AstraZeneca P/L (Sydney, Australia); Boehringer Ingelheim P/L (Sydney, Australia); GlaxoSmithKline Australia P/L (Sydney, Australia); Pfizer Australia P/L (Sydney, Australia); Department of Health Policy Research Programme (London, United Kingdom); Clement Clarke International (London, United Kingdom); Boehringer Ingelheim (Lisbon, Portugal); Pfizer (Lisbon, Portugal); SwedishHeart and Lung Foundation (Uppsala, Sweden); Swedish Association Against Heart and Lung Diseases (Uppsala, Sweden); GlaxoSmithKline (Uppsala, Sweden); GlaxoSmithKline (Tartu, Estonia); AstraZeneca (Tartu, Estonia); Eesti Teadusfond (Estonian Science Foundation) (Tartu, Estonia); AstraZeneca (Maastricht, The Netherlands); CIRO HORN (Maastricht, The Netherlands); Sher-i-Kashmir Institute of Medical Sciences (Srinagar, India); Foundation for Environmental Medicine (Mumbai, India); Volkart Foundation (Mumbai, India); Boehringer Ingelheim (Sousse, Tunisia); Philippines College of Physicians (Nampicuan, Philippines); Philippines College of Chest Physicians (Nampicuan, Philippines); AstraZeneca (Nampicuan, Philippines); Boehringer Ingelheim (Nampicuan, Philippines); GlaxoSmithKline (Nampicuan, Philippines); Orient Euro Pharma (Nampicuan, Philippines); Otsuka Pharma (Nampicuan, Philippines); United Laboratories Philippines (Nampicuan, Philippines); National Heart and Lung Institute (Pune, India); Imperial College, London (Pune, India); Wellcome Trust (Ile-Ife, Nigeria); National Population Commission, Ile-Ife (Ile-Ife, Nigeria); Osun State, Nigeria (Ile-Ife, Nigeria); Kasturba Hospital (Mumbai, India) The initial BOLD program was funded in part by unrestricted educational grants to the coordinating Centre in Portland, Oregon from Aventis, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Novartis, Pfizer, Schering-Plough, Sepracor, and the University of Kentucky. The BOLD Study is currently funded by a grant from the Wellcome Trust (085790/Z/08/Z), which supports the London, UK Co-ordinating Centre. Additional local support for BOLD sites was provided by: Boehringer Ingelheim China. (Guangzhou, China); the Turkish Thoracic Society, Boehringer Ingelheim, and Pfizer (Adana, Turkey); Altana, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Sharpe & Dohme, Novartis, Salzburger Gebietskrankenkasse, and the Salzburg local government (Salzburg, Austria); Research for International Tobacco Control, the International Development Research Centre, the South African Medical Research Council, a South African Thoracic Society GlaxoSmithKline Pulmonary Research Fellowship, and the University of Cape Town Lung Institute (Cape Town, South Africa); the Landspitali-University Hospital-Scientific Fund, GlaxoSmithKline Iceland, and AstraZeneca Iceland (Reykjavik, Iceland); GlaxoSmithKline Pharmaceuticals, Polpharma, Ivax Pharma Poland, AstraZeneca Pharma Poland, ZF Altana Pharma, Pliva Krakow, Adamed, Novartis Poland, Linde Gaz Polska, Lek Polska, Tarchomi ~ nskie Zaklady Farmaceutyczne Polfa, Starostwo Proszowice, Skanska, Zasada, Agencja Mienia Wojskowego w Krakowie, Telekomunikacja Polska, Biernacki, Biogran, Amplus Bucki, Skrzydlewski, Sotwin, and Agroplon (Krakow, Poland); Boehringer Ingelheim, and Pfizer Germany (Hannover, Germany); the Norwegian Ministry of Health's Foundation for Clinical Research, and Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway); AstraZeneca, Boehringer Ingelheim, Pfizer, and GlaxoSmithKline (Vancouver, Canada); the Marty Driesler Cancer Project (Lexington, KY); Altana, Boehringer Ingelheim (Phil), GlaxoSmithKline, Pfizer, Philippine College of Chest Physicians, Philippine College of Physicians, and United Laboratories (Phil) (Manila, Philippines); Air Liquide Healthcare P/L, AstraZeneca P/L, Boehringer Ingelheim P/L, GlaxoSmithKline Australia P/L, Pfizer Australia P/L (Sydney, Australia), Department of Health Policy Research Programme, Clement Clarke International (London, United Kingdom); Boehringer Ingelheim, Pfizer (Lisbon, Portugal), SwedishHeart and Lung Foundation, the Swedish Association Against Heart and Lung Diseases, and GlaxoSmithKline (Uppsala, Sweden); GlaxoSmithKline, AstraZeneca, and Eesti Teadusfond (Estonian Science Foundation) (Tartu, Estonia); AstraZeneca, and CIRO HORN (Maastricht, The Netherlands); Sher-i-Kashmir Institute of Medical Sciences, and Srinagar, J& K (Srinagar, India); Foundation for Environmental Medicine, Kasturba Hospital, and Volkart Foundation (Mumbai, India); Boehringer Ingelheim (Sousse, Tunisia); Philippines College of Physicians, Philippines College of Chest Physicians, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Orient Euro Pharma, Otsuka Pharma, and United Laboratories Philippines (Nampicuan, Philippines); National Heart and Lung Institute, Imperial College, London (Pune, India); the Wellcome Trust, National Population Commission, Ile-Ife, and Osun State, Nigeria (Ile-Ife, Nigeria). Apart from the financial support mentioned above, no further funding was provided for the current work.