Thomas Elizabeth T, Glasziou Paul, Dobler Claudia C
Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.
Gold Coast University Hospital, Southport, Australia.
Breathe (Sheff). 2019 Mar;15(1):e8-e19. doi: 10.1183/20734735.0354-2018.
Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term "overdiagnosis" in general has been associated with variable definitions. In connection with efforts to reduce low-value care, "overdiagnosis" has been defined as a true positive diagnosis of a condition that is not associated with any harm in the diagnosed person. It is, however, unclear how the term "overdiagnosis" is used in the COPD literature. We conducted a rapid review of the literature to explore how the terms "overdiagnosis" and "misdiagnosis" are used in the context of COPD. Electronic searches of Medline were conducted from inception to October 2018, to identify primary studies that reported on over- and/or misdiagnosis of COPD using these terms. 28 articles were included in this review. Overdiagnosis and misdiagnosis in COPD were found to be used to describe five main concepts: 1) physician COPD diagnosis despite normal spirometry (14 studies); 2) discordant results for COPD diagnosis based on different spirometry-based definitions for airflow obstruction (10 studies); 3) COPD diagnosis based on pre-bronchodilator spirometry results (three studies); 4) comorbidities ( heart failure or asthma) that affect spirometry and have clinical features which overlap with COPD (two studies); and 5) normalisation of abnormal (post-bronchodilator) spirometry at follow-up (one study). The terms "overdiagnosis" and "misdiagnosis" were often used interchangeably and almost always referred to a false positive diagnosis. Performing (technically correct) spirometry with correct interpretation of the results could probably reduce misdiagnosis in a large proportion of the misdiagnosed cases of COPD. In addition, guidelines need to provide a more acceptable consensus spirometric definition of airflow obstruction.
In the COPD literature, the terms "overdiagnosis" and "misdiagnosis" are often used interchangeably and almost always refer to a false positive diagnosis.Use of spirometry with correct interpretation of the results can avoid a substantial proportion of cases of misdiagnosis of COPD.
To explore the use of the terms "overdiagnosis" and "misdiagnosis" in the COPD literature.To identify the main sources of overdiagnosis and misdiagnosis in COPD.
慢性阻塞性肺疾病（COPD）诊断过程中的挑战可能导致诊断错误分类，包括过度诊断。一般来说，“过度诊断”一词的定义各不相同。在努力减少低价值医疗服务的背景下，“过度诊断”被定义为对一种在被诊断者身上不会造成任何伤害的疾病做出的真阳性诊断。然而，目前尚不清楚“过度诊断”一词在COPD文献中是如何使用的。我们对文献进行了快速回顾，以探讨“过度诊断”和“误诊”这两个术语在COPD背景下的使用情况。对Medline进行了从创刊到2018年10月的电子检索，以确定使用这些术语报告COPD过度诊断和/或误诊的原始研究。本综述纳入了28篇文章。发现COPD中的过度诊断和误诊用于描述五个主要概念：1）尽管肺功能正常但医生诊断为COPD（14项研究）；2）基于不同的基于肺功能的气流阻塞定义，COPD诊断结果不一致（10项研究）；3）基于支气管扩张剂前肺功能结果诊断COPD（3项研究）；4）影响肺功能且具有与COPD重叠的临床特征的合并症（心力衰竭或哮喘）（2项研究）；5）随访时异常（支气管扩张剂后）肺功能正常化（1项研究）。“过度诊断”和“误诊”这两个术语经常互换使用，几乎总是指假阳性诊断。进行（技术上正确的）肺功能检查并正确解读结果可能会在很大比例的COPD误诊病例中减少误诊。此外，指南需要提供一个更可接受的关于气流阻塞的肺功能检查共识定义。
在COPD文献中，“过度诊断”和“误诊”这两个术语经常互换使用，几乎总是指假阳性诊断。使用肺功能检查并正确解读结果可以避免很大比例的COPD误诊病例。
探讨“过度诊断”和“误诊”这两个术语在COPD文献中的使用情况。确定COPD中过度诊断和误诊的主要来源。
