[Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors]

J de Miguel Díez, J L Izquierdo Alonso, J Molina París, J M Rodríguez González-Moro, P de Lucas Ramos, G Gaspar Alonso-Vega
Archivos de Bronconeumología 2003, 39 (5): 203-8

OBJECTIVE: The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease.

MATERIAL AND METHODS: This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists.

RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD.

CONCLUSIONS: Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.

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