Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Abstract

Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV 1 and FEV 1 /FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions:The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.Keywords: Pulmonary disease, chronic obstructive/diagnosis; Primary health care; Spirometry. ResumoObjetivo: Estimar a prevalência de DPOC não diagnosticada entre indivíduos com fatores de risco para a doença atendidos em unidades básicas de saúde (UBS) na cidade de Aparecida de Goiânia (GO). Métodos: Os critérios de inclusão foram ter idade ≥ 40 anos, ter história de tabagismo > 20 maços-ano ou de exposição à queima de biomassa > 80 horas-ano e procurar atendimento médico em uma das UBS selecionadas. Todos os indivíduos incluídos no estudo foram submetidos a espirometria para a definição diagnóstica de DPOC. Resultados: Foram avaliados com sucesso 200 indivíduos, a maioria do sexo masculino. A média de idade foi de 65,9 ± 10,5 anos. Tiveram confirmação diagnóstica de DPOC 63 indivíduos. Desses, apenas 18 haviam sido previamente diagnosticados com DPOC (taxa de subdiagnóstico de 71,4%). Não houve diferenças significantes entre os subgrupos com e sem diagnóstico prévio de DPOC em relação a fatores demográficos e fatores de risco. Entretanto, houve diferenças significantes entre esses subgrupos em relação à presença de expectoração, chiado e dispneia (p = 0,047, p = 0,005 e p = 0,047, respectivamente). Os valores de VEF 1 e VEF 1 /CVF, em percentual do previsto, foram significativamente menores nos indivíduos com diagnóstico prévio de DPOC. A DPOC foi predominantemente leve a moderada em ambos os subgrupos. Conclusões: A taxa de subdiagnóstico da DPOC foi alta nas UBS estudadas. Um terço dos...

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

“…In the present study, the underdiagnosis rate was 70.0% for new COPD cases diagnosed until the end of the nine-year follow-up period and 62.3% for all of the participants in the follow-up phase of the PLATINO study. Similar rates have been reported in a study involving primary health care clinics in the city of Aparecida de Goiânia, Brazil, ( 12 ) and in cross-sectional epidemiological studies conducted in other countries, such as Spain ( 13 ) and the USA, (14)- 71.4%, 78.2%, and 74.9%, respectively-which shows that underdiagnosing COPD is not a problem observed only in developing countries. This means that spirometry is underused, a finding that has also been reported in a study conducted in Spain.…”

“…No presente estudo, o subdiagnóstico foi de 70,0% para os novos casos de DPOC diagnosticados após nove anos de seguimento e de 62,3% ao se considerar todos os indivíduos que participaram da fase de seguimento do estudo PLATINO. Taxas similares também foram reportadas em uma amostra de unidades básicas de saúde em Aparecida de Goiânia, Brasil ( 12 ) e em estudos epidemiológicos transversais realizados em outros países, como Espanha ( 13 ) e EUA ( 14 ) (71,4%, 78,2% e 74,9%, respectivamente), demonstrando que a ausência do diagnóstico de DPOC não é uma realidade somente de países em desenvolvimento. Isso reflete que a espirometria é um exame subutilizado, à semelhança do que foi encontrado em um estudo realizado na Espanha.…”

Underdiagnosis of respiratory diseases during an economic downturn and the need for spirometry as a screening test

“…In a very interesting paper published recently in the Brazilian Journal of Pulmonology, Queiroz et al ( 1 ) reported a COPD underdiagnosis rate of 71.4% in a primary health care setting. In addition, the authors observed that only 5.6% of the subjects previously diagnosed with COPD had undergone pulmonary function tests (PFTs).…”

Hospitalized patients with COPD: analysis of prior treatment

“…( 2 ) In a study evaluating patients treated at primary care clinics in the city of Aparecida de Goiânia, Brazil, 71% had never undergone spirometry and therefore had an unconfirmed diagnosis of COPD. ( 4 ) …”