Need to be BOLD about misdiagnosis of COPD

About half of patients who self-report a diagnosis of COPD have probably been misdiagnosed, according to an Australian study representative of community-living adults.

A sub-study of more than 3,000 adults ≥40 years from the Burden of Obstructive Lung Disease (BOLD) study found 1.8% had a self reported diagnosis of COPD and met both fixed cut-off (<0.70 FEV1/FVC ) and lower limit of normal (5th percentile) definitions of airflow obstruction.

A further 2.2%, self-reporting a diagnosis of COPD but not meeting either criteria, were probably misdiagnosed.

As well, 6.9% probably had undiagnosed COPD as they met both criteria for diagnosis but did not self report a diagnosis of COPD.

The study found 81.5% of the cohort had normal lung function.

“Given the burden of COPD, there need to be efforts to increase case finding approaches in undiagnosed cases, and a diagnostic review of those who self report COPD to identify those who have probably been misdiagnosed,” it said.

The researchers, including senior investigator Professor Michael Abramson from Monash University, said misdiagnosis may divert the focus from other underlying causes of the patient’ symptoms and expose them to unnecessary, costly and ineffective treatments.

The study, published in the International Journal of COPD, said the target population for case finding undiagnosed COPD were age >60, wheezing, shortness of breath and a BMI <25.

Similarly the target population for finding probably misdiagnosed COPD were age <60 years, female, no wheezing and BMI >25.

“Health professionals should ensure that patients with a documented history of COPD and these specific characteristics have the diagnosis objectively confirmed by post-bronchodilator spirometry to minimise misdiagnosis.”

“From our analyses and other literature, some symptoms may be due to obesity, increasing misdiagnosis amongst middle aged people who are overweight or obese.”

“Given that approximately two-thirds of the Australian adult population were overweight or obese in 2017–18, it may be particularly relevant to review the COPD diagnosis in this group.”

The study said the findings also reinforce the need for improved access to spirometry in general practice.

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