Aging and disability affect misdiagnosis of COPD in elderly asthmatics - The SARA study
Aging and disability affect misdiagnosis of COPD in elderly asthmatics - The SARA study
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DOI：
10.1378/chest.123.4.1066
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发表时间：
2003-04-01
期刊：
影响因子：
9.6
通讯作者：
Rengo, F
中科院分区：
文献类型：
--
作者：
Bellia, V;Battaglia, S;Rengo, F
研究目的：本研究调查了老年哮喘患者中COPD的误诊或未被识别的程度，并确定了导致此类患者误诊和诊断不足的因素。设计：一项涉及24家意大利肺科或老年病机构的多中心研究。患者：128名哮喘患者（98名妇女，76.6%），年龄73 +/- 6.4岁（平均值+/- SD）选自Salute Respiratoria nell'Anziano的队列方法：对所有患者进行临床评估，包括临床病史和肺功能测定法与支气管扩张剂试验。哮喘的诊断是根据国际指南提出的适用于老年人群的标准。进行多维老年评估，以估计身体和认知障碍和情绪状态。最后，呼吸系统疾病的诊断，以前由一名医生，如果有的话，recorded.Results：哮喘患者，COPD已被不正确的诊断为19.5%，而27.3%的哮喘患者没有报告任何以前的哮喘诊断。误诊的主要相关因素是年龄较大和残疾。相反，诊断不足与更好的功能条件，肺功能测定法表示，甚至当喘息或显着反应的支气管扩张剂testinghappened.Conclusions：哮喘在老年人经常混淆COPD。误诊可能与年龄较大和残疾程度较高有关。轻度功能障碍的哮喘患者尽管有明显的呼吸道症状提示哮喘，但仍可能诊断不足。
Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients.Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions.Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 +/- 6.4 years (mean +/- SD) were selected from the cohort of the Salute Respiratoria nell'Anziano (respiratory health in the elderly) study.Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded.Results: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred.Conclusions: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma.