The diagnostic accuracies of chronic obstructive pulmonary disease (COPD) in general practice: the results of the MAGIC (Manchester Airways Group Identifying COPD) study

Frank, Timothy L; Hazell, Michelle L; Linehan, Mary; Pi, Felip

doi:10.1016/j.pcrj.2006.07.007

Cited by 26 publications

(28 citation statements)

References 15 publications

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“…2,6,22 This difference is consistent with past studies that found COPD to be underdiagnosed or misdiagnosed quite frequently. Frank and colleagues 23 found that less than half of patients with Global Obstructive Lung Disease categories 2-4 by spirometry had a diagnosis of COPD recorded in their primary care medical records. Prevalence rates based on administrative data may be biased in the opposite direction.…”

Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

et al. 2015

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CMAJ OPEN, 3(1) E15Research CMAJ OPEN C hronic obstructive pulmonary disease (COPD) is a substantial source of morbidity and mortality in Canada and globally. Estimates place the worldwide prevalence at 9%-10% from physiologic-based studies and 3%-8% from studies based on physician-or patient-reported diagnosis or symptoms.1,2 Globally, COPD is rated as the fifth leading cause of death, and ninth in contributions to loss of disability-adjusted life years.3,4 A recent systematic review of COPD epidemiology worldwide identified 12 Canadian studies, which produced prevalence estimates that ranged from 3% to 12%, depending on the method used.5 Canadian data from a study using spirometry to screen a populationbased sample suggest a rate of about 10%. 6 There are limited data on COPD either alone or in combination with other chronic diseases from primary care settings.In other countries, the limited reports on COPD prevalence in primary care settings show marked variation depending on the method of identification of illness. A study from the United Kingdom based on electronic records in the Computerized Patient Records Database found the prevalence of physician-diagnosed COPD to be less than 1% for women and only 1.35% for men.7 Another practice-based research network study from the UK that invited participants in a postal survey to come for spirometry if they had either symptoms or a smoking history found a much higher prevalence (4.1% overall, 9.6% in patients over 40 yr).8 A recent Spanish study using data from electronic medical records (EMRs) found a physician-diagnosed prevalence of 3.2%, 90% of whom were also found to have at least 1 comorbid condition. Background: Chronic obstructive pulmonary disease (COPD) is mostly managed within primary care, but there is little Canadian evidence from this setting. This study was undertaken to determine the prevalence of physician-diagnosed COPD in primary care practices, and the degree of comorbidity with other chronic conditions, and to assess patterns of medication prescribing.

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Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

et al. 2015

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“…Since the introduction of newer drugs for COPD, especially tiotropium and combination inhaled corticosteroid/long-acting β 2-agonists, pharmaceutical costs have increased by over 70% to around AU$215 per person with COPD per annum. 5 COPD is still underdiagnosed in most countries, especially in its early stages, [6][7][8] with a major contributory factor being underutilisation of spirometry in primary care. [9][10][11][12][13] Spirometry in the general practice or office setting is feasible with the development of accurate, stable, portable devices, 14,15 and the majority of practices in the UK and Australia now report ownership of a spirometer.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with misdiagnosis of COPD in primary care

Walters

Nelson

et al. 2011

Primary Care Respiratory Journal

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Aim: To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care. Methods:A cross-sectional study was performed in 31 (19%) practices in one Australian state. 341 patients with COPD (database diagnosis or current use of tiotropium plus GP confirmation) completed spirometry and questionnaires. Predictors of misclassification were investigated with multi-level mixed-effects logistic regression allowing for clustering by practice.Results: Spirometric confirmation of COPD (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7) was not present in 107 (31%) patients; 60 (56%) had normal lung function, seven (7%) had scalloped flow-volume curves and FEV1 <80% predicted, 40 (37%) had restriction (FVC <80% predicted). Among 107 misclassified patients the bronchodilators used were tiotropium in 26% and long-acting β2-agonists in 22%. The likelihood of misclassification increased with overweight/obesity (odds ratio (OR) 2.66; 95% CI 1.50 to 4.70) and self-reported allergic rhinitis/hay fever (OR 1.72; 95% CI 1.13 to 2.64) after adjustment for age, gender, and smoking.Conclusions: Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometry is essential to avoid inappropriate management.

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“…Spirometry is an essential tool in diagnosing COPD; however, the use of spirometry in medical practice in Denmark varies widely and is in general too low – despite a high degree of availability. An increase in the use of spirometry in patients with respiratory symptoms has been recorded in some studies [12,22]. In the study by Ulrik et al [25] among Danish general practitioners, the number of performed spirometries is very low – especially when taking into account that spirometry is a well-paid procedure.…”

Section: Discussionmentioning

confidence: 99%

“…breathlessness) and disabilities as a life condition rather than an illness [11]. Moreover, patients with COPD are often under-or misdiagnosed [6,12–14]. Therefore, increased awareness in the general population about COPD is an important factor in the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Lack of awareness towards smoking-related health risks, symptoms related to COPD, and attitudinal factors concerning smoking: an Internet-based survey conducted in a random sample of the Danish general population

Sikjær

Hilberg

Fløe

et al. 2018

European Clinical Respiratory Journal

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Background: Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality globally, several studies have shown little awareness of COPD in the general population. The awareness of COPD in the Scandinavian countries is, however, sparsely investigated. Objective: The aim of this study was to explore the awareness in the general Danish population of smoking-related health risks and symptoms related to COPD and attitudinal factors concerning smoking. Design: Adults aged 18 years or older were randomly selected to reflect the background population. An Internet-based questionnaire was conducted in January–February 2015. Results: A total of 1002 answered the questionnaire (515 males; 487 females). In total, 17.7% were current smokers (men: 15.5%–women: 19.9%). More smokers and ex-smokers knew the symptoms of COPD compared to never-smokers (p < 0.001). Ex-smokers had undergone more pulmonary function tests than smokers and never-smokers (p < 0.001) and significantly more men than women who had undergone pulmonary function test.Ex-smokers were more likely to rate cancer as the most feared disease (p = 0.026) than the smokers. Of the smokers, 28% did not regard COPD as a deadly disease and significantly more smokers than ex-/never-smokers believed that smoking cessation should not be mandatory before treatment of COPD and asthma (p < 0.001). Conclusion: Overall, smokers, ex-, and never-smokers had little knowledge of COPD regarding aetiology, symptoms, and severity thus emphasizing the necessity of early detection of COPD and more focus on spirometry in general practice, especially amongst smokers.There is a great discrepancy between the attitude of smokers and ex-/never-smokers towards mandatory smoking cessation before receiving treatment of smoking-related diseases. Funding: GlaxoSmithKline Pharma A/S Brøndby, financially supported the collecting of data by Voxmeter A/S. The authors had full access to the raw data and did not receive any financially support.

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The diagnostic accuracies of chronic obstructive pulmonary disease (COPD) in general practice: the results of the MAGIC (Manchester Airways Group Identifying COPD) study

Cited by 26 publications

References 15 publications

Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

Factors associated with misdiagnosis of COPD in primary care

Lack of awareness towards smoking-related health risks, symptoms related to COPD, and attitudinal factors concerning smoking: an Internet-based survey conducted in a random sample of the Danish general population

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