title: Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more.
abstract: OBJECTIVE
  To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD) in primary care and to examine how spirometry findings fit with general practitioners' (GPs) diagnoses.
  
  
  METHODS
  Patients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009-2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared.
  
  
  RESULTS
  Among 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P < 0.001). The κ agreement between last clinical diagnosis of COPD and COPD based on spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9%) than in patients diagnosed with COPD only (6.8%, P = 0.003).
  
  
  CONCLUSIONS
  The ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found.
authors.affiliation: General Practice Research Unit, Department of Community Medicine, University of Tromsø, Norway. hasse.melbye@uit.no
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.forename: Elin
authors.initials: E
authors.lastname: Drivenes
authors.forename: Lene G
authors.initials: LG
authors.lastname: Dalbak
authors.forename: Tone
authors.initials: T
authors.lastname: Leinan
authors.forename: Svein
authors.initials: S
authors.lastname: Høegh-Henrichsen
authors.forename: Anders
authors.initials: A
authors.lastname: Ostrem
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012042:Registries; D013147:Spirometry; D014797:Vital Capacity