Chapman K R, Tashkin D P, Pye D J
Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Chest. 2001 Jun;119(6):1691-5. doi: 10.1378/chest.119.6.1691.
COPD is thought to be more prevalent among men than women, a finding usually attributed to higher smoking rates and more frequent occupational exposures of significance for men. However, smoking prevalence has increased among women and there is evidence that women may be more susceptible to the adverse pulmonary function effects of smoking than men. There may also be underdiagnosis and misdiagnosis of COPD in both sexes because objective measures of lung function are underused.
We undertook the present study to determine if there is gender bias in the diagnosis of COPD, such that women are less likely than men to receive a diagnosis of COPD. We also attempted to determine if underuse of lung function measurements was a factor in any bias detected.
We surveyed a random sample of 192 primary-care physicians (96 American and 96 Canadian; 154 men and 38 women) using a hypothetical case presentation and a structured interview. The case of cough and dyspnea in a smoker was presented in six versions differing only in the age and sex of the patient. After presentation of the history and physical findings, physicians were asked to state the most probable diagnosis and to choose the diagnostic studies needed. Physicians were then presented with spirometric findings of moderate or severe obstruction without significant bronchodilator response, and the questions repeated. Finally, the negative outcome of an oral steroid trial was described.
Initially, COPD was given as the most probable diagnosis significantly more often for men than women (58% vs 42%; p < 0.05). The likelihood of a COPD diagnosis increased significantly and initial differences between sexes decreased as objective information was provided. After spirometry, COPD diagnosis rates for men and women were 74% vs 66% (p = not significant); after the steroid trial 85% vs 79% (p = not significant). Only 22% of physicians would have requested spirometry after the initial presentation.
In North America, primary-care physicians underdiagnosed COPD, particularly in women. Spirometry reduces the risk of underdiagnosis and gender bias but is underused.
慢性阻塞性肺疾病（COPD）被认为在男性中比在女性中更为普遍，这一发现通常归因于男性较高的吸烟率以及更频繁地接触具有重要意义的职业暴露因素。然而，女性吸烟率已有所上升，并且有证据表明女性可能比男性更容易受到吸烟对肺功能的不良影响。由于肺功能的客观检测方法未得到充分利用，COPD在男性和女性中都可能存在漏诊和误诊的情况。
我们开展本研究以确定在COPD的诊断中是否存在性别偏见，即女性比男性更不容易被诊断为COPD。我们还试图确定肺功能检测未得到充分利用是否是检测到的任何偏见的一个因素。
我们使用一个假设病例介绍和结构化访谈对192名初级保健医生（96名美国医生和96名加拿大医生；154名男性和38名女性）的随机样本进行了调查。一名吸烟者咳嗽和呼吸困难的病例以六个版本呈现，这些版本仅在患者的年龄和性别上有所不同。在呈现病史和体格检查结果后，要求医生说出最可能的诊断并选择所需的诊断研究。然后向医生展示中度或重度阻塞且无明显支气管扩张剂反应的肺量计检查结果，并重复这些问题。最后，描述了口服类固醇试验的阴性结果。
最初，COPD被列为最可能的诊断时，男性的比例显著高于女性（58%对42%；p<0.05）。随着提供客观信息，COPD诊断的可能性显著增加，性别之间的初始差异减小。在进行肺量计检查后，男性和女性的COPD诊断率分别为74%对66%（p=无显著性差异）；在类固醇试验后为85%对79%（p=无显著性差异）。只有22%的医生在最初呈现病例后会要求进行肺量计检查。
在北美，初级保健医生对COPD诊断不足，尤其是在女性中。肺量计检查可降低漏诊风险和性别偏见，但未得到充分利用。
