Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

Abstract

AimsTo describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD) in primary care and to examine how spirometry findings fit with general practitioners’ (GPs) diagnoses.MethodsPatients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009–2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared.ResultsAmong 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P < 0.001). The κ agreement between last clinical diagnosis of COPD and COPD based on spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9%) than in patients diagnosed with COPD only (6.8%, P = 0.003).ConclusionThe ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found.

Continuing to Confront COPD International Patient Survey: methods, COPD prevalence, and disease burden in 2012&ndash;2013

“…While only 10% of the final sample comprised patients who had symptoms only, it is possible that some patients with lung diseases other than COPD may have been included under this definition. For example, a differential diagnosis between asthma and COPD can be challenging, especially when spirometric confirmation is not possible 44,45…”

Drop in lung function during asthma and COPD exacerbations &ndash; can it be assessed without spirometry?

“…Of the 380 patients who met for baseline registration between April 2009 and March 2010, 376 were considered to be in a stable phase of their disease and were included in the study. Out of those, 210 were diagnosed with asthma by their GPs, 74 with COPD, and 92 with both asthma and COPD 11. They were all asked to visit their GP within 2–3 days if they experienced exacerbations of their lung disease the following 12 months.…”

“…One good reason for doing this is the difficulties in differentiating between asthma and COPD in many patients with obstructive lung disease 11,16. A second justification is the similar challenges in the two diseases when it comes to treating exacerbations with oral corticosteroids.…”

Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study

“…Like studies in children, the studies of asthma prevalence in adults above 40 years and in the elderly face the problem of the lack of an universally accepted epidemiological definition of asthma [9,10], which could induce under or overdiagnosis [10,11]. Particularly, in the older group, the differentiation of asthma from chronic obstructive pulmonary disease (COPD) could be difficult [6,8,12,13], not only because both conditions could coexist (overlap syndrome) [12], but also symptoms and functional alterations can be similar [14]. In common epidemiologic practice, a clinical definition is used for asthma (wheezing, physician-diagnosed or treatment for asthma) [9,15] and a spirometry definition is used for COPD [16].…”

“…In common epidemiologic practice, a clinical definition is used for asthma (wheezing, physician-diagnosed or treatment for asthma) [9,15] and a spirometry definition is used for COPD [16]. Although a proportion of subjects with asthma could have a post-bronchodilator FEV 1 /FVC570%, a diagnosis of COPD is generally not accepted with this ratio 70% [13,14]. Underdiagnosis of asthma is common in adults, particularly in the elderly, and has been related to reduced perception or under reported symptoms and the difficulty in differentiating this condition from COPD as mentioned, and other comorbidities such as chronic heart failure [6][7][8]17].…”