Llordés Montserrat, Jaén Angeles, Almagro Pere, Heredia Josep Luis, Morera Josep, Soriano Joan B, Miravitlles Marc
a Primary Care Center Terrassa Sud. Hospital Universitari Mutua de Terrassa, University of Barcelona , Barcelona , Spain.
COPD. 2015 Aug;12(4):404-12. doi: 10.3109/15412555.2014.974736.
The prevalence of COPD is high, and most cases remain undiagnosed. In contrast, some patients labeled and treated as COPD do not have spirometric confirmation. Our objective was to determine the prevalence of COPD among smokers aged 45 years or older and investigate the accuracy of diagnosis of COPD in primary care. A population-based, epidemiological study was conducted in a primary care centre among subjects older than 45 years with a history of smoking. The participants underwent a clinical questionnaire and spirometry with bronchodilator test. Additionally, participants with newly diagnosed COPD, defined as postbronchodilator FEV1/FVC<0.7, underwent 4-week treatment with formoterol and budesonide to rule out reversible airflow obstruction. A total of 1,738 individuals (84.4% male) with a mean age of 59.9 years were included. The prevalence of COPD was 24.3% (95%, CI 22.3-26.4), with an overall underdiagnosis of 56.7%. Patients with COPD were older, more frequently male, with a lower body mass index, a longer history of smoking, lower educational level, previous occupational exposure, and more cardiovascular co-morbidity (all p < 0.001). After 4 weeks of treatment, 16% of initially obstructed patients had normal spirometry; in addition, 15.6% of individuals with a diagnosis of COPD did not have airflow obstruction. One out of four smokers 45 years or older presenting in primary care have airflow obstruction, mostly undiagnosed. However, among those with an initial diagnosis of COPD up to 16% will normalise spirometry after 4 weeks of treatment. There is also a significant number of individuals misdiagnosed with COPD.
慢性阻塞性肺疾病（COPD）的患病率很高，且大多数病例仍未得到诊断。相比之下，一些被诊断为COPD并接受治疗的患者并未通过肺功能测定得到确诊。我们的目的是确定45岁及以上吸烟者中COPD的患病率，并调查初级保健中COPD诊断的准确性。在一个初级保健中心对45岁以上有吸烟史的受试者进行了一项基于人群的流行病学研究。参与者接受了临床问卷调查和支气管扩张剂试验的肺功能测定。此外，新诊断为COPD（定义为支气管扩张剂后FEV1/FVC<0.7）的参与者接受了4周的福莫特罗和布地奈德治疗，以排除可逆性气流受限。共纳入1738人（84.4%为男性），平均年龄59.9岁。COPD的患病率为24.3%（95%，CI 22.3 - 26.4），总体漏诊率为56.7%。COPD患者年龄更大，男性更常见，体重指数更低，吸烟史更长，教育水平更低，有既往职业暴露史，心血管合并症更多（所有p<0.001）。治疗4周后，16%最初有气流受限的患者肺功能测定结果正常；此外，15.6%被诊断为COPD的个体没有气流受限。在初级保健中就诊的45岁及以上吸烟者中，四分之一有气流受限，大多未被诊断。然而，在那些最初诊断为COPD的患者中，高达16%的人在治疗4周后肺功能测定结果将恢复正常。也有相当数量的个体被误诊为COPD。
