title: Early detection of asthma and chronic obstructive pulmonary disease in primary care patients.
abstract: BACKGROUND
  Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma.
  
  
  METHODS
  In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry.
  
  
  RESULTS
  There were 2074 patients, 38.4% men, their mean age being 54 +/- 15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95% CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465).
  
  
  CONCLUSIONS
  A significant number of patients seen in the general practitioner's office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.
authors.affiliation: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Vukoja
authors.forename: Predrag
authors.initials: P
authors.lastname: Rebić
authors.forename: Zorica
authors.initials: Z
authors.lastname: Lazić
authors.forename: Marija
authors.initials: M
authors.lastname: Mitić Milikić
authors.forename: Branislava
authors.initials: B
authors.lastname: Milenković
authors.forename: Biljana
authors.initials: B
authors.lastname: Zvezdin
authors.forename: Ivan
authors.initials: I
authors.lastname: Cekerevac
authors.forename: Mirjana
authors.initials: M
authors.lastname: Jovancević Drvenica
authors.forename: Sanja
authors.initials: S
authors.lastname: Hromis
authors.forename: Ivan
authors.initials: I
authors.lastname: Kopitović
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D001294:Attitude to Health; D042241:Early Diagnosis; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015272:Pulmonary Medicine; D014797:Vital Capacity