Diagnostic labeling of COPD in five Latin American cities.
BACKGROUND
COPD is a major worldwide problem with a rising prevalence. Despite its importance, there is a lack of information regarding underdiagnosis and misdiagnosis of COPD in different countries. As part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar study, we examined the relationship between prior diagnostic label and airway obstruction in the metropolitan areas of five Latin American cities (São Paulo, Santiago, Mexico City, Montevideo, and Caracas).


METHODS
A two-stage sampling strategy was used in each of the five areas to obtain probability samples of adults aged >or= 40 years. Participants completed a questionnaire that included questions on prior diagnoses, and prebronchodilator and postbronchodilator spirometry. A study diagnosis of COPD was based on airway obstruction, defined as a postbronchodilator FEV(1)/FVC < 0.70.


RESULTS
Valid spirometry and prior diagnosis information was obtained for 5,303 participants; 758 subjects had a study diagnosis of COPD, of which 672 cases (88.7%) had not been previously diagnosed. The prevalence of undiagnosed COPD was 12.7%, ranging from 6.9% in Mexico City to 18.2% in Montevideo. Among 237 subjects with a prior COPD diagnosis, only 86 subjects (36.3%) had postbronchodilator FEV(1)/FVC < 0.7, while 151 subjects (63.7%) had normal spirometric values. In the same group of 237 subjects, only 34% reported ever undergoing spirometry prior to our study.


CONCLUSIONS
Inaccurate diagnostic labeling of COPD represents an important health problem in Latin America. One possible explanation is the low rate of spirometry for COPD diagnosis.
Tálamo
Carlos
C
Universidad Central de Venezuela, Facultad de Medicina, Hospital Universitario de Caracas, Cátedra de Neumonologia Piso 8, Caracas 1040, Venezuela. carlostalamo@hotmail.com
de Oca
Maria Montes
MM
Halbert
Ron
R
Perez-Padilla
Rogelio
R
Jardim
José Roberto B
JR
Muiño
Adriana
A
Lopez
Maria Victorina
MV
Valdivia
Gonzalo
G
Pertuzé
Julio
J
Moreno
Dolores
D
Menezes
Ana Maria B
AM
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002677:Chile / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012494:Sampling Studies; D013147:Spirometry; D014505:Urban Population; D014583:Uruguay / Q000453:epidemiology; D014687:Venezuela / Q000453:epidemiology