Causes of misdiagnosis of chronic obstructive pulmonary disease: A systematic scoping review

Hangaard, Stine; Helle, Tina; Nielsen, Claus Vinther; Hejlesen, Ole

doi:10.1016/j.rmed.2017.05.015

Cited by 57 publications

(51 citation statements)

References 80 publications

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“…COPD misdiagnosis and misclassification has been linked to the threshold for defining obstruction and is widely discussed. [5][6][7][8][9][10][11][12] Moreover, COPD misdiagnosis and misclassification may be caused by the use of pre-bronchodilator spirometry instead of post-bronchodilator spirometry. A false positive diagnosis of COPD can lead to harmful treat-ment for a patient without COPD as well as unawareness of and therefore no treatment for other possible reasons causing the underlying air-flow obstruction.…”

Section: Introductionmentioning

confidence: 99%

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC

et al. 2018

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BACKGROUND: COPD is a leading cause of morbidity and mortality worldwide. Spirometry is the most common lung function test for diagnosing COPD with a post-bronchodilator FEV 1 /FVC < 0.70 confirming the presence of the disease. However, diagnosticians appear reluctant to use bronchodilators, which have been linked to the misdiagnosis of COPD. Therefore, we investigated whether the threshold for diagnosing COPD should be modified when diagnosing COPD based on prebronchodilator spirometry. METHODS: Data from 23,433 participants were merged from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Participants were excluded for having no post-bronchodilator spirometry, for being below the age of 40, and for having asthma or lung cancer. These exclusion criteria resulted in 680 participants being included in the present study. Participants with COPD were defined as those with a post-bronchodilator FEV 1 /FVC < 0.70. The threshold for diagnosing COPD based on pre-bronchodilator FEV 1 /FVC was varied while calculating accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: Diagnosing COPD based on pre-bronchodilator FEV 1 /FVC < 0.70 contributes to the misdiagnosis of COPD through poor classification rates. By adjusting the threshold and diagnosing COPD based on a pre-bronchodilator FEV 1 /FVC < 0.66, the overall classification rates increase noticeably, resulting in a 15% increase in accuracy. CONCLUSION: We suggest a slight adjustment using pre-bronchodilator FEV 1 /FVC < 0.66 when diagnosing COPD based on pre-bronchodilator spirometry. This approach could prevent cases of misdiagnosed COPD, which can lead to potentially harmful treatment of people who do not have COPD and foregone treatment in patients with COPD.

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Section: Introductionmentioning

confidence: 99%

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC

et al. 2018

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“…Spirometry criteria are also an important factor in COPD diagnosis. 21 GOLD argues that the threshold of post-bronchodilator FEV 1 /FVC Ͻ 0.7 should remain, 22 whereas multiple studies argue that LLN should be used as an alternative threshold for defining COPD. [23][24][25][26][27] Woodruff et al 28 found that current or former smokers who did not meet the existing criteria for COPD had evidence of airway disease.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

2018

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“…La calidad técnica de la espirometría es muy significativa por cuanto una prueba mal hecha podría inducir a errores de interpretación tanto en el diagnóstico como en el tratamiento (10,11). La Asociación Latinoamericana de Tórax (ALAT) viene trabajando desde hace más de 20 años para unificar criterios y mejorar la calidad de la espirometría (12).…”

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Evaluation of the acceptability, reproducibility and quality of spirometry performed in an adult pneumology service

Martín

2018

An. Fac. Cienc. Méd. (Asunción)

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Evaluación de la aceptabilidad, reproductividad y calidad de las espirometrías realizadas en un servicio neumológico de adultos Evaluation of the acceptability, reproducibility and quality of spirometry performed in an adult pneumology service San Martin, VíctorProf. Adjunto. Cátedra de Neumología. Facultad de Ciencias Médicas. Universidad Nacional de Asunción. RESUMENLas enfermedades pulmonares requieren estudios auxiliares de gran precisión. La espirometría es una prueba diagnóstica y de seguimiento de mucha importancia en el manejo de las patologías respiratorias, especialmente las obstructivas. Esta investigación presenta las indicaciones de su uso, y evaluó los errores en las espirometrías de 70 pacientes realizadas en un consultorio neumológico, considerando los criterios de aceptabilidad, reproductividad y calidad. Se detectó que más del 95% de espirometrías alcanzan el nivel de buena calidad, siendo este dato similar al de estudios más amplios. Los errores más frecuentes fueron la terminación temprana del procedimiento y diferencia no aceptable entre las principales variables medidas. Es una gran preocupación de las sociedades científicas neumológicas garantizar que estos estudios tengan la máxima fiabilidad posible, para eso es importante un monitoreo periódico de la calidad de las espirometrías y así asegurar que tengan la mayor utilidad, con profesionales sanitarios adecuadamente formados para el efecto. Palabras Clave: Espirometría, Control De Calidad. Fecha de recepción el 01 de marzo del 2018; aceptado el 26 de Marzo del 2018 San Martín V et. al.  Evaluación de la aceptabilidad, reproductividad y calidad de las espirometrías realizadas… An. ABSTRACTPulmonary diseases require very precise auxiliary studies. Spirometry is a diagnostic and monitoring test of great importance in the management of respiratory pathologies, especially obstructive ones. This research presents the indications of its use, and evaluated the errors in the spirometry of 70 patients performed in a pulmonology clinic, considering the criteria of acceptability, reproducibility and quality. It was detected that more than 95% of spirometries reach the level of good quality, this data being similar to that of larger studies. The most frequent errors were the early termination of the procedure and a not acceptable difference between the main variables measured. It´s a great concern of pulmonological scientific societies to ensure that these studies have the highest possible reliability, for that reason, it´s important to periodically monitor the quality of spirometries and thus ensure that they have the greatest utility, with health professionals adequately trained for this purpose.

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Causes of misdiagnosis of chronic obstructive pulmonary disease: A systematic scoping review

Cited by 57 publications

References 80 publications

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC

Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

Evaluation of the acceptability, reproducibility and quality of spirometry performed in an adult pneumology service

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Causes of misdiagnosis of chronic obstructive pulmonary disease: A systematic scoping review

Cited by 57 publications

References 80 publications

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV1/FVC

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV1/FVC

Characteristics of Subjects With Undiagnosed COPD Based on Post-Bronchodilator Spirometry Data

Evaluation of the acceptability, reproducibility and quality of spirometry performed in an adult pneumology service

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Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC

Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV₁/FVC