PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis

Abstract

OBJECTIVE:To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase.METHODS:The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase.RESULTS:The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD.CONCLUSIONS:The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.

Clinical and epidemiological profile of patients from the home care program of Federal District Brazil

“…The error or absence of a diagnosis makes the occurrence of effective interventions unlikely. Moreover, 83.3% of individuals diagnosed with COPD in São Paulo received no pharmacological treatment, 47.3% were not advised to stop smoking and 72.4% did not take the flu shot (Moreira et al, 2014). These findings show COPD is an underdiagnosed and undertreated disease, which may have serious consequences for patients, such as increased morbidity and mortality, and result in a considerable economic impact on the healthcare system.…”

Indicação, acesso e utilização de medicamentos para doenças respiratórias crônicas no Brasil: resultados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), 2014

“…Da mesma forma, a distinção entre enfisema e bronquite crônica é problemática, já que em grande parte dos casos há fenótipo misto, e influencia pouco as decisões terapêuticas 28 . Em nosso estudo, também não foram abordadas as problemáticas relacionadas ao subdiagnóstico e subtratamento das doenças respiratórias crônicas, que são amplamente descritas 30,31,32,33 , assim como o tratamento inadequado mesmo quando o diagnóstico é realizado adequadamente 34,35 .…”

“…Salientandose que essa conclusão se aplica para DPOC por meio da redução do tabagismo, mas não para asma; por outro lado, o maior acesso aos serviços de saúde tende a reduzir o subdiagnóstico e subtratamento, elevando a prevalência, dados estes não estimados no nosso trabalho. Essa estabilidade no diagnóstico para DPOC também foi observada no seguimento de nove anos do Estudo PLATINO 31 , que mostrou que pacientes subdiagnosticados seriam aqueles com menos sintomatologia, os quais poderiam passar despercebidos pelos médicos. Neste nosso estudo, as estimativas de DPOC e asma foram avaliadas em conjunto, não permitindo realizar inferências sobre a prevalência destas doenças de forma individualizada.…”

As pequenas vias aéreas na doença pulmonar obstrutiva crônica

“…Existem cerca de três milhões de mortes anualmente em todo mundo por DPOC. Segundo o Projeto PLATINO, a prevalência da doença na cidade de São Paulo foi de 15,8% em 2006 3 .…”