Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population

Christian Ghattas,¹ Allen Dai,² David J Gemmel,³ Magdi H Awad<sup>2

1</sup>Department of Internal Medicine, St Elizabeth Health Center, Youngstown, OH, USA; ²Northeast Ohio Medical University College of Pharmacy, Rootstown, OH, USA; ³Department of Medical Education and Research, St Elizabeth Health Center, Youngstown, OH, USA

Introduction: While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking.
Objective: The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center.
Methods: A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV₁) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV₁ greater than 200 mL and greater than 12%.
Results: Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had nonreversible obstruction.
Conclusion: Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.

Keywords: chronic obstructive pulmonary disease, COPD, misdiagnosis, over diagnosis, spirometry, uninsured, underserved