title: Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population.
abstract: BACKGROUND
  While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking.
  
  
  OBJECTIVE
  The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center.
  
  
  METHODS
  A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%.
  
  
  RESULTS
  Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction.
  
  
  CONCLUSIONS
  Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.
authors.affiliation: Department of Internal Medicine, St Elizabeth Health Center, Youngstown, OH, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Ghattas
authors.affiliation: Northeast Ohio Medical University College of Pharmacy, Rootstown, OH, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Dai
authors.affiliation: Department of Medical Education and Research, St Elizabeth Health Center, Youngstown, OH, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gemmel
authors.affiliation: Northeast Ohio Medical University College of Pharmacy, Rootstown, OH, USA.
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Awad
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001993:Bronchodilator Agents / Q000008:administration & dosage; D018680:Cholinergic Antagonists / Q000008:administration & dosage; D003951:Diagnostic Errors; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008507:Medically Underserved Area; D017057:Medically Uninsured; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013147:Spirometry; D014797:Vital Capacity; D035862:Vulnerable Populations
chemical_list: D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists
keywords: COPD; chronic obstructive pulmonary disease; misdiagnosis; over diagnosis; spirometry; underserved; uninsured