Overdiagnosis & Underdiagnosis of COPD


19 May 2022 542 Views By MARI

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among individuals over the age of 65 and accounts for approximately 1 million hospitalizations each year in the United States (Spero et al., 2017). Patients having symptoms such as chronic cough, dyspnea, and/or sputum production are seriously considered for clinical diagnosis of COPD; however, solely relying on these symptoms for COPD diagnosis tends to overestimate COPD prevalence as the symptoms may overlap with other pulmonary and non-pulmonary diagnoses (Spero et al., 2017). 


Asthma, restrictive lung disease, congestive heart failure, and pulmonary fibrosis are only a few of the multitude of conditions that can present similar signs and symptoms of COPD (Spero et al., 2017). Additionally, accurate COPD diagnosis among those with the disease is critical in initiating timely risk factor modification and therapy to minimize unnecessary costs and potential side effects in those unlikely to benefit from therapy (Lamprecht et al., 2015).


One particular study concluded that one out of three patients admitted to the hospital with COPD diagnosis may be misdiagnosed and mistreated (Spero et al., 2017). Furthermore, this was highly attributed to comorbidity where obesity, obstructive sleep apnea, hypertension, coronary artery disease, and congestive heart failure were strongly associated with misdiagnosis (Spero et al., 2017). Also, underdiagnosis of COPD is highly prevalent where globally four in five individuals are underdiagnosed (Lamprecht et al., 2015)


Another study found that 81.4% of overall global COPD cases were undiagnosed and determined that the worldwide determinants of COPD underdiagnosis are male sex, younger aged individuals, never and current smoking, lower level of education, absence of reported symptoms, lack of previous spirometry, and milder severity of airflow limitation (Lamprecht et al., 2015). Therefore, in order to reduce the prevalence of overdiagnosed or underdiagnosed cases of COPD, increasing confirmatory testing and wider usage of spirometry need to be prioritized (Spero et al., 2017; Lamprecht et al., 2015). 


Spero, K., Bayasi, G., Beaudry, L., Barber, K., & Khorfan, F. (2017). Overdiagnosis of 

COPD in hospitalized patients. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2417-2423. https://doi.org/10.2147/COPD.S139919

Lamprecht, B., Soriano, J. B., Studnicka, M., Kaiser, B., Vanfleteren, L. E., Gnatiuc, L., 

Burney, P., Miravitlles, M., García-Rio, F., Akbari, K., Ancochea, J., Menezes, A. M., Perez-Padilla, R., Montes de Oca, M., Torres-Duque, C. A., Caballero, A., González-García, M., & Buist, S. (2015). Determinants of Underdiagnosis of COPD in national and international surveys. Chest, 148(4), 971–985. https://doi.org/10.1378/chest.14-2535  


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