Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice

Nicholas A. Zwar, Guy B. Marks, Oshana Hermiz, Sandy Middleton, Elizabeth J. Comino, Iqbal Hasan, Sanjyot Vagholkar, Stephen F. Wilson

Research output: Contribution to journalArticleResearchpeer-review

43 Citations (Scopus)

Abstract

Objectives: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. Design, setting and participants: General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Main outcome measures: Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. Results: 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49% male). Of these, 257 (57.8%) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. Conclusions: A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.

Original languageEnglish
Pages (from-to)168-171
Number of pages4
JournalMedical Journal of Australia
Volume195
Issue number4
Publication statusPublished - 15 Aug 2011
Externally publishedYes

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General Practice
Chronic Obstructive Pulmonary Disease
Spirometry
Comorbidity
Bronchodilator Agents
Asthma
Pulmonary Medicine
Diagnostic Errors
General Practitioners
Primary Health Care
Vaccination
Smoking
Odds Ratio
Quality of Life
Demography
Outcome Assessment (Health Care)

Cite this

Zwar, N. A., Marks, G. B., Hermiz, O., Middleton, S., Comino, E. J., Hasan, I., ... Wilson, S. F. (2011). Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Medical Journal of Australia, 195(4), 168-171.
Zwar, Nicholas A. ; Marks, Guy B. ; Hermiz, Oshana ; Middleton, Sandy ; Comino, Elizabeth J. ; Hasan, Iqbal ; Vagholkar, Sanjyot ; Wilson, Stephen F. / Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. In: Medical Journal of Australia. 2011 ; Vol. 195, No. 4. pp. 168-171.
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abstract = "Objectives: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. Design, setting and participants: General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Main outcome measures: Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. Results: 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49{\%} male). Of these, 257 (57.8{\%}) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6{\%}) had asthma only, 82 (18.4{\%}) had normal spirometry, and 90 (20.2{\%}) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. Conclusions: A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.",
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Zwar, NA, Marks, GB, Hermiz, O, Middleton, S, Comino, EJ, Hasan, I, Vagholkar, S & Wilson, SF 2011, 'Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice' Medical Journal of Australia, vol. 195, no. 4, pp. 168-171.

Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. / Zwar, Nicholas A.; Marks, Guy B.; Hermiz, Oshana; Middleton, Sandy; Comino, Elizabeth J.; Hasan, Iqbal; Vagholkar, Sanjyot; Wilson, Stephen F.

In: Medical Journal of Australia, Vol. 195, No. 4, 15.08.2011, p. 168-171.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Wilson, Stephen F.

PY - 2011/8/15

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N2 - Objectives: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. Design, setting and participants: General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Main outcome measures: Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. Results: 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49% male). Of these, 257 (57.8%) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. Conclusions: A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.

AB - Objectives: To compare the clinical diagnosis of chronic obstructive pulmonary disease (COPD) with results of post-bronchodilator spirometry in general practice, and examine practitioner, practice and patient characteristics associated with agreement between clinical and spirometric diagnoses. Design, setting and participants: General practitioners from practices in Sydney identified eligible patients aged 40-80 years seen in the past year and prescribed respiratory medications whom they regarded as having COPD. Between November 2006 and April 2008, we collected information on the GPs and their practices, and demographic information, smoking status, comorbidities, respiratory medicines use, vaccination status, quality of life and spirometry results for participating patients. Main outcome measures: Frequency of COPD diagnosis on spirometry; odds ratios for characteristics associated with agreement between clinical and spirometric diagnoses. Results: 56 GPs from 44 practices participated in the study. Of 1144 eligible patients, 445 were recruited (mean age, 65 years; 49% male). Of these, 257 (57.8%) had post-bronchodilator spirometry consistent with COPD ± asthma, 16 (3.6%) had asthma only, 82 (18.4%) had normal spirometry, and 90 (20.2%) had other spirometric diagnoses. Having a spirometer in the practice was not predictive of agreement between clinical and spirometric diagnoses. Older patient age was significantly associated with correct diagnosis, while higher numbers of comorbidities were associated with misdiagnosis. Conclusions: A substantial proportion of patients clinically identified as having COPD in general practice do not have the condition according to spirometric criteria, with inaccurate diagnosis more common in patients with comorbidities. Policy and practice change is needed to support the use of spirometry in primary care.

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Zwar NA, Marks GB, Hermiz O, Middleton S, Comino EJ, Hasan I et al. Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Medical Journal of Australia. 2011 Aug 15;195(4):168-171.