Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London.
Division of Population Health Sciences, University of Dundee, Dundee.
Br J Gen Pract. 2018 Nov;68(676):e775-e782. doi: 10.3399/bjgp18X699389. Epub 2018 Sep 24.
Asthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment.
To quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.
Patients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires.
The prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information.
In total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% ( = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD.
A concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.
哮喘和慢性阻塞性肺疾病（COPD）有许多共同的特征和症状，在初级保健中，两种疾病的鉴别诊断可能很困难。本研究探索了在初级保健环境中两种疾病之间可能存在的重叠。
量化 COPD 患者同时诊断为哮喘的频率，以及哮喘患者同时诊断为 COPD 的频率，在英国初级保健中。此外，该研究旨在确定可能误诊和漏诊的程度。
在独立的验证研究中，从英国临床实践研究数据库（CPRD）中确定了经验证的哮喘和 COPD 患者，并通过审查全科医生问卷来确认疾病。
根据 CPRD 编码、全科医生问卷和要求的额外信息，检查经验证的哮喘和 COPD 患者中并发哮喘和 COPD 的患病率。
共确定了 400 例 COPD 患者和 351 例初级保健中的哮喘患者。在已确诊的哮喘患者中，有 15%（52 例）曾接受过诊断性 COPD Read 代码，尽管在已确诊的哮喘患者中，只有 14.8%（95%置信区间[CI]为 11.3 至 19.0）可能患有 COPD。超过一半（52.5%，210 例）患有已确诊 COPD 的患者曾接受过诊断性哮喘 Read 代码。然而，当考虑支持哮喘诊断的额外证据时，只有 14.5%（95%CI=11.2 至 18.3）患有已确诊 COPD 的患者可能同时患有哮喘。
并发哮喘和 COPD 诊断似乎仅影响相对少数的 COPD（14.5%）或哮喘（14.8%）患者。在 COPD 患者中，哮喘诊断可能被过度记录。
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