title: Chronic obstructive pulmonary disease in Brazilian primary care: Diagnostic competence and case-finding.
abstract: OBJECTIVE
  The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding.
  
  
  METHODS
  34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142).
  
  
  RESULTS
  For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk.
  
  
  CONCLUSIONS
  COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation.
authors.affiliation: Care and Public Health Research Institute, Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. rhamers@hotmail.com
authors.forename: Raph
authors.initials: R
authors.lastname: Hamers
authors.forename: Sander
authors.initials: S
authors.lastname: Bontemps
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.forename: Ruy
authors.initials: R
authors.lastname: Souza
authors.forename: Júlio
authors.initials: J
authors.lastname: Penaforte
authors.forename: Niels
authors.initials: N
authors.lastname: Chavannes
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002983:Clinical Competence; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry