title: Is spirometry properly used to diagnose COPD? Results from the BOLD study in Salzburg, Austria: a population-based analytical study.
abstract: BACKGROUND
  Current guidelines recommend spirometry to confirm a diagnosis of chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  To investigate whether a self-reported diagnosis of COPD is associated with prior spirometry and whether a correct diagnosis of COPD is more likely when spirometry was performed.
  
  
  METHODS
  We used data from the population-based Austrian Burden of Obstructive Lung Disease (BOLD) study. Participants were aged >40 years and completed post-bronchodilator spirometry. Reported COPD diagnosis and reported prior lung function test were based on questionnaire. Persistent airflow limitation was defined as post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio <0.7, corresponding with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) grade I+, and GOLD grade II+ was also investigated. A correct diagnosis of COPD was defined as a reported physician's diagnosis of COPD and the presence of persistent airflow limitation.
  
  
  RESULTS
  68 (5.4%) of 1,258 participants reported a prior physician's diagnosis of COPD. Of these, only 17 (25.0%) reported a lung function test within the past 12 months and 46 (67.6%) at any time in the past. The likelihood for a correct COPD GOLD grade I+ diagnosis was similar among subjects reporting a lung function test during the last 12 months (likelihood ratio 2.07, 95% CI 0.89 to 5.50) and those not reporting a lung function during the last 12 months (likelihood ratio 2.78, 95% CI 1.58 to 4.87). Similar likelihood ratios were seen when GOLD grade II+ was investigated and when lung function was reported at any time in the past.
  
  
  CONCLUSIONS
  One-third of subjects with a reported diagnosis of COPD never had a lung function test. When spirometry was reported, this did not increase the likelihood of a correct COPD diagnosis.
authors.affiliation: Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria. b.lamprecht@salk.at
authors.forename: Bernd
authors.initials: B
authors.lastname: Lamprecht
authors.forename: Andrea
authors.initials: A
authors.lastname: Mahringer
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kaiser
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Buist
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D013147:Spirometry / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014797:Vital Capacity / Q000502:physiology
references.citation: Eur Respir J. 2010 Oct;36(4):758-65
references.pmid: 19996189
references.citation: Ann Intern Med. 2008 Apr 1;148(7):535-43
references.pmid: 18316746
references.citation: Am J Med. 2007 Aug;120(8 Suppl 1):S23-7
references.pmid: 17678940
references.citation: Prim Care Respir J. 2009 Sep;18(3):216-23
references.pmid: 19688142
references.citation: Wien Klin Wochenschr. 2007;119(17-18):513-8
references.pmid: 17943402
references.citation: Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
references.pmid: 17507545
references.citation: Eur Respir J. 2006 Nov;28(5):945-52
references.pmid: 16870668
references.citation: Monaldi Arch Chest Dis. 2005 Mar;63(1):6-12
references.pmid: 16035558
references.citation: Prim Care Respir J. 2009 Sep;18(3):130-47
references.pmid: 19684995
references.citation: N Engl J Med. 2004 Mar 4;350(10):1005-12
references.pmid: 14999112
references.citation: Am J Respir Crit Care Med. 1995 Sep;152(3):1107-36
references.pmid: 7663792
references.citation: Lancet. 2009 Aug 29;374(9691):721-32
references.pmid: 19716965
references.citation: Respir Med. 2011 Oct;105(10):1507-15
references.pmid: 21549584
references.citation: Respir Care. 2005 Dec;50(12):1639-48
references.pmid: 16318645
references.citation: Respiration. 2005 Sep-Oct;72(5):471-9
references.pmid: 16210885
references.citation: Chest. 2003 May;123(5):1684-92
references.pmid: 12740290
references.citation: Eur Respir J. 2004 Jun;23(6):932-46
references.pmid: 15219010
references.citation: Thorax. 2009 Oct;64(10):863-8
references.pmid: 19553233
references.citation: Am J Respir Crit Care Med. 1999 Jan;159(1):179-87
references.pmid: 9872837
references.citation: BMJ. 2008 Mar 15;336(7644):598-600
references.pmid: 18326503
references.citation: Respiration. 2011;81(6):476-82
references.pmid: 20720402
references.citation: Chest. 2007 Oct;132(4):1162-8
references.pmid: 17550939
references.citation: Chest. 2000 Oct;118(4):981-9
references.pmid: 11035667
references.citation: Prim Care Respir J. 2012 Jun;21(2):180-6
references.pmid: 22430040
references.citation: Lancet. 1997 May 24;349(9064):1498-504
references.pmid: 9167458
references.citation: Respir Med. 2008 May;102(5):738-43
references.pmid: 18222684
references.citation: Lancet. 2009 Aug 29;374(9691):704-11
references.pmid: 19716962
references.citation: COPD. 2005 Jun;2(2):277-83
references.pmid: 17136954
references.citation: Chest. 2007 Jan;131(1):29-36
references.pmid: 17218553