Walters Julia A, Walters E Haydn, Nelson Mark, Robinson Andrew, Scott Jenn, Turner Paul, Wood-Baker Richard
Menzies Research Institute, University of Tasmania, Tasmania, Australia.
Prim Care Respir J. 2011 Dec;20(4):396-402. doi: 10.4104/pcrj.2011.00039.
To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care.
A cross-sectional study was performed in 31 (19%) practices in one Australian state. 341 patients with COPD (database diagnosis or current use of tiotropium plus GP confirmation) completed spirometry and questionnaires. Predictors of misclassification were investigated with multi-level mixed-effects logistic regression allowing for clustering by practice.
Spirometric confirmation of COPD (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7) was not present in 107 (31%) patients; 60 (56%) had normal lung function, seven (7%) had scalloped flow-volume curves and FEV1 <80% predicted, 40 (37%) had restriction (FVC <80% predicted). Among 107 misclassified patients the bronchodilators used were tiotropium in 26% and long-acting β2-agonists in 22%. The likelihood of misclassification increased with overweight/obesity (odds ratio (OR) 2.66; 95% CI 1.50 to 4.70) and self-reported allergic rhinitis/hay fever (OR 1.72; 95% CI 1.13 to 2.64) after adjustment for age, gender, and smoking.
Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometry is essential to avoid inappropriate management.
评估澳大利亚初级医疗中慢性阻塞性肺疾病（COPD）的误诊情况。
在澳大利亚一个州的31家（19%）医疗机构中开展了一项横断面研究。341例COPD患者（数据库诊断或正在使用噻托溴铵且经全科医生确认）完成了肺功能测定和问卷调查。采用多水平混合效应逻辑回归分析误诊的预测因素，该分析考虑了医疗机构层面的聚类效应。
107例（31%）患者不存在COPD的肺功能测定确诊情况（1秒用力呼气容积/用力肺活量（FEV1/FVC）比值<0.7）；60例（56%）肺功能正常，7例（7%）流量-容积曲线呈扇形且FEV1<预测值的80%，40例（37%）存在限制（FVC<预测值的80%）。在107例误诊患者中，使用的支气管扩张剂为噻托溴铵的占26%，长效β2受体激动剂的占22%。在对年龄、性别和吸烟情况进行校正后，超重/肥胖（比值比（OR）2.66；95%置信区间1.50至4.70）和自我报告的过敏性鼻炎/花粉症（OR 1.72；95%置信区间1.13至2.64）会增加误诊的可能性。
在初级医疗中基于症状诊断COPD不可靠，尤其是对于超重患者，因此诊断性肺功能测定对于避免不恰当的治疗至关重要。
