de Miguel Díez J, Izquierdo Alonso J L, Molina París J, Rodríguez González-Moro J M, de Lucas Ramos P, Gaspar Alonso-Vega G
Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid. España.
Arch Bronconeumol. 2003 May;39(5):203-8. doi: 10.1016/s0300-2896(03)75362-9.
The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease.
This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists.
Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD.
Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.
本研究旨在评估西班牙基层医疗医生和肺病专家诊断慢性阻塞性肺疾病（COPD）所采用的方法，并分析影响该疾病正确诊断的因素。
本观察性、描述性、横断面多中心研究从西班牙各地区的基层医疗医生和肺病专家诊所中选取分层随机样本。
898名受试者中，568名（63.2%）存在气道阻塞，92名（10.3%）不符合COPD功能标准，238名（26.5%）未进行肺功能测试以确诊及确定疾病严重程度。基层医疗医生正确分类了29.3%的患者，而肺病专家的正确诊断率为84.8%。在基层医疗医生管理的病例中，38.6%以及肺病专家治疗的病例中10.2%的正确诊断基于临床和/或放射学标准。49.1%的基层医疗医生可进行肺功能测定，而肺病专家的病例中有97.8%可进行（p<0.001）。此外，仅有29.9%的基层医疗机构有技术人员负责此项检查，相比之下，专科肺病医疗机构的这一比例为97.8%（p<0.001）。肺功能测定在COPD诊断中的应用与患者护理水平（基层或专科）、基层医疗机构中该检查的可及性、居住地点以及患者因COPD导致的临时缺勤情况有关。
许多COPD患者被误诊，尤其是在基层医疗中。不同护理水平的诊断程序存在差异。肺功能测定的可及性是正确诊断COPD的重要因素。
