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Undiagnosed and Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the BOLD Australia Study

Authors Petrie K, Toelle BG, Wood-Baker R, Maguire GP, James AL, Hunter M, Johns DP, Marks GB, George J, Abramson MJ

Received 16 October 2020

Accepted for publication 30 December 2020

Published 25 February 2021 Volume 2021:16 Pages 467—475

DOI https://doi.org/10.2147/COPD.S287172

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Kate Petrie,1 Brett G Toelle,2,3 Richard Wood-Baker,4 Graeme P Maguire,5 Alan L James,6,7 Michael Hunter,8,9 David P Johns,4 Guy B Marks,2,10 Johnson George,1,11 Michael J Abramson11

1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; 2Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 3Sydney Local Health District, Sydney, NSW, Australia; 4College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia; 5Western Clinical School, University of Melbourne, Melbourne, Australia and General Internal Medicine, Western Health, Melbourne, VIC, Australia; 6Sir Charles Gairdner Hospital, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Perth, WA, Australia; 7University of Western Australia, Medical School, Perth, WA, Australia; 8School of Population and Global Health, University of Western Australia, Perth, WA, Australia; 9Busselton Population Medical Research Institute, Busselton, WA, Australia; 10South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; 11School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Correspondence: Michael J Abramson
School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
Tel +61 3 9903 0573
Fax +61 3 9903 0556
Email [email protected]

Purpose: Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD.
Patients and Methods: This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cross-sectional study of community dwelling adults randomly selected from six study sites, chosen to provide a representative sample of the Australian population (n= 3357). Participants were grouped by COPD diagnostic criteria based on spirometry and self-reported diagnosis. Odds ratios for predictors of undiagnosed and misdiagnosed were estimated using logistic regression.
Results: Of the BOLD Australia sample, 1.8% had confirmed COPD, of whom only half self-reported a diagnosis of COPD. A further 6.9% probably had COPD, but were undiagnosed. The priority target population for case finding of undiagnosed COPD was aged ≥ 60 years (particularly those ≥ 75 years), with wheezing, shortness of breath and a body mass index (BMI) < 25kg/m2. The priority target population for identifying and reviewing misdiagnosed COPD was aged < 60 years, female, with no wheezing and a BMI ≥ 25kg/m2.
Conclusion: Challenges continue in accurately diagnosing COPD and greater efforts are needed to identify undiagnosed and misdiagnosed individuals to ensure an accurate diagnosis and the initiation of appropriate management in order to reduce the burden of COPD.

Keywords: case finding, diagnosis, spirometry, epidemiology

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