Casas Herrera Alejandro, Montes de Oca Maria, López Varela Maria Victorina, Aguirre Carlos, Schiavi Eduardo, Jardim José R
Fundación Neumológica Colombiana, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Los Chaguaramos, 1030, Universidad Central de Venezuela, Caracas, Venezuela.
PLoS One. 2016 Apr 13;11(4):e0152266. doi: 10.1371/journal.pone.0152266. eCollection 2016.
Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.
To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.
COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed.
1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I-II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry.
COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.
认识到基层医疗中慢性阻塞性肺疾病（COPD）的漏诊和误诊情况有助于改善疾病诊断。PUMA是一项在阿根廷、哥伦比亚、委内瑞拉和乌拉圭开展的国际基层医疗研究。
评估基层医疗中COPD的漏诊和误诊情况，并确定在此环境下与COPD漏诊相关的因素。
COPD定义为支气管扩张剂使用后1秒用力呼气容积/用力肺活量（FEV1/FVC）<0.70且低于正常下限（LLN）。既往诊断为医生自我报告的肺气肿、慢性支气管炎或COPD诊断。那些肺功能检查确诊为COPD的患者被认为既往诊断正确，而那些不符合肺功能标准的患者则被误诊。符合肺功能标准但既往未诊断的个体被视为漏诊。
共访谈了1743例患者，1540例完成了肺功能检查，其中309例（支气管扩张剂使用后FEV1/FVC<0.70）和226例（LLN）患有COPD。以支气管扩张剂使用后FEV1/FVC<0.70为标准的漏诊率为77%，以LLN为标准的漏诊率为73%。总体而言，102例患者既往有COPD诊断，71/102例患者（69.6%）既往诊断正确，31/102例（30.4%）根据支气管扩张剂使用后FEV1/FVC≥0.70被误诊。漏诊与较高的体重指数（≥30 kg/m2）、较轻的气道阻塞（GOLD I-II级）、黑色皮肤、无呼吸困难、喘息、过去一年无加重或住院史有关。过去一年未就诊或仅就诊于全科医生的患者漏诊风险更高。既往进行过肺功能检查的患者中，COPD漏诊率（65.8%）和误诊率（26.4%）较低。
COPD漏诊是基层医疗中的一个主要问题。在此环境下，应优先提供肺功能检查。
