Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
Int J Chron Obstruct Pulmon Dis. 2021 Feb 25;16:467-475. doi: 10.2147/COPD.S287172. eCollection 2021.
Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD.
This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cross-sectional study of community dwelling adults randomly selected from six study sites, chosen to provide a representative sample of the Australian population (n= 3357). Participants were grouped by COPD diagnostic criteria based on spirometry and self-reported diagnosis. Odds ratios for predictors of undiagnosed and misdiagnosed were estimated using logistic regression.
Of the BOLD Australia sample, 1.8% had confirmed COPD, of whom only half self-reported a diagnosis of COPD. A further 6.9% probably had COPD, but were undiagnosed. The priority target population for case finding of undiagnosed COPD was aged ≥60 years (particularly those ≥75 years), with wheezing, shortness of breath and a body mass index (BMI) <25kg/m. The priority target population for identifying and reviewing misdiagnosed COPD was aged <60 years, female, with no wheezing and a BMI ≥25kg/m.
Challenges continue in accurately diagnosing COPD and greater efforts are needed to identify undiagnosed and misdiagnosed individuals to ensure an accurate diagnosis and the initiation of appropriate management in order to reduce the burden of COPD.
肺量测定术对于确诊 COPD 是必要的，但许多患者是根据临床表现和/或胸部 X 光检查来诊断的。还有一些人没有到基层医疗机构进行病例发现，因此未被诊断出来。我们旨在确定：（a）与未确诊的 COPD 相关的因素；和（b）与 COPD 潜在误诊相关的因素。
本分析使用了来自负担性阻塞性肺病（BOLD）的数据，这是一项对来自六个研究地点的社区居住成年人的横断面研究，这些地点的选择旨在提供澳大利亚人群的代表性样本（n=3357）。参与者根据肺量测定术和自我报告的诊断结果分为 COPD 诊断标准组。使用逻辑回归估计未确诊和误诊的预测因素的优势比。
在 BOLD 澳大利亚样本中，有 1.8%的人确诊为 COPD，其中只有一半人自我报告患有 COPD。还有 6.9%的人可能患有 COPD，但未被诊断出来。发现未确诊 COPD 的重点目标人群是年龄≥60 岁（特别是≥75 岁）的人，有喘息、呼吸急促和身体质量指数（BMI）<25kg/m。确定和审查误诊 COPD 的重点目标人群是年龄<60 岁、女性、无喘息和 BMI≥25kg/m 的人。
在准确诊断 COPD 方面仍然存在挑战，需要做出更大的努力来识别未确诊和误诊的个体，以确保准确诊断并开始适当的管理，从而减轻 COPD 的负担。
