title: The diagnosis of COPD in primary care; gender differences and the role of spirometry.
abstract: BACKGROUND
  Females with exacerbations of Chronic Obstructive Pulmonary Disease now account for one half of all hospital admissions for that condition and rates have been increasing over the last few decades. Differences in presentations of disease between genders have been shown in several conditions and this study explores whether there are inter gender biases in probable diagnoses in those suspected to have COPD.
  
  
  METHODS
  445 individuals with a provisional diagnosis by their General Practitioner of "suspected COPD" or "definite COPD" were referred to a community Respiratory Assessment unit (CRAU) for tests including spirometry. Gender, demographics, respiratory symptoms and respiratory medical history were recorded. The provisional diagnoses were compared with the final diagnosis made after spirometry and respiratory specialist nurse review and the provisional diagnosis was either confirmed as correct or refuted as unlikely.
  
  
  RESULTS
  Significantly more men (87.5%) had their diagnosis of "definite COPD" confirmed compared to 73.9% of women (p = 0.021). When the GP suggested a provisional diagnosis of "suspected COPD" (n = 265) at referral, this was confirmed in 60.9% of men and only 43.2% of women (p = 0.004). There was a different symptom pattern between genders with women being more likely to report allergies, symptoms starting earlier in life, and being less likely than men to report breathlessness as the main symptom.
  
  
  CONCLUSIONS
  These results may suggest a difference between genders in some of the clinical features of COPD and a difference in likelihood of a GPs provisional diagnosis of COPD being correct. The study reiterates the absolute importance of spirometry in the diagnosis of COPD.
authors.affiliation: Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom. Electronic address: nicola.roberts@gcu.ac.uk.
authors.forename: N J
authors.initials: NJ
authors.lastname: Roberts
authors.affiliation: Kings College Hospital NHS Foundation Trust London, London, United Kingdom.
authors.forename: I S
authors.initials: IS
authors.lastname: Patel
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: M R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D012737:Sex Factors; D013147:Spirometry / Q000379:methods* / Q000706:statistics & numerical data; D014852:Wales / Q000453:epidemiology
keywords: COPD; Diagnosis; Spirometry