Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
Chest. 2019 Aug;156(2):277-288. doi: 10.1016/j.chest.2019.01.015. Epub 2019 Jan 31.
There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012.
A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV/FVC < 0.7).
Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication.
False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.
有几篇报道称 COPD 存在漏诊的情况，但是对于 COPD 的过度诊断和过度治疗的了解甚少。我们描述了在 2003 年至 2012 年间参与 BOLD 研究的 20 个国家的 23 个人群样本中，过度诊断和肺量计定义的假阳性 COPD 的患病率，以及它们与过度治疗的关系。
当参与者报告医生诊断为 COPD 但支气管扩张剂后肺量计未阻塞（FEV/FVC>LLN）时，考虑 COPD 的假阳性诊断。使用固定比值标准（FEV/FVC<0.7）进行了额外的分析。
在 16177 名参与者中，有 919 名（5.7%）报告了以前的医生诊断为 COPD。在 569 名受试者（61.9%）中支气管扩张剂后肺量计未阻塞：假阳性 COPD。使用固定比值标准也观察到了类似的过度诊断率（55.3%）。在排除了报告患有“慢性支气管炎”或“肺气肿”的参与者的亚组分析中（n=220），37.7%的人没有气流受限。假阳性 COPD 的特定部位患病率差异很大，从低收入和中等收入国家的 1.9%到高收入国家的 4.9%。在多变量分析中，过度诊断在女性中更为常见，与较高的教育程度；以前和现在的吸烟；喘息、咳嗽和咳痰的存在；以及哮喘或心脏病的并存医学诊断有关。在假阳性 COPD 患者中，有 45.7%的人报告目前正在使用呼吸药物。在排除报告有哮喘的患者后，仍有 34.4%的肺功能正常的患者使用呼吸药物。
假阳性 COPD 很常见。这可能使未阻塞的患者面临呼吸药物可能产生的不良反应。
