Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over
Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over
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DOI：
10.1080/02770900500448738
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发表时间：
2006-01-01
影响因子：
1.9
通讯作者：
Halbert, RJ
中科院分区：
文献类型：
--
作者：
Tinkelman, DG;Price, DB;Halbert, RJ
慢性阻塞性肺疾病（COPD）经常被误诊为哮喘，导致不适当的治疗和次优的患者结局。作为一项前瞻性研究的一部分，我们对有阻塞性肺疾病病史的患者进行了既往诊断标签与基于肺功能测定结果的研究诊断进行了比较。我们招募了40岁或以上的患者，既往诊断或药物治疗与阻塞性肺疾病一致。患者通过随机邮寄到苏格兰阿伯丁和科罗拉多丹佛的初级保健实践中招募。受试者报告了慢性支气管炎或肺气肿（CBE）和哮喘的既往诊断。受试者接受了使用支气管扩张剂前后的肺功能测定。COPD的研究诊断定义为使用支气管扩张剂后1秒用力呼气量/用力肺活量（FEV 1/FVC）< 0.70。597例患者完成了肺量测定检查，其中235例（39.4%）研究诊断为COPD。在基于肺量测定的COPD研究诊断的受试者中，121例（51.5%）报告既往诊断为哮喘，但未同时诊断为CBE，89例（37.9%）报告既往诊断为CBE，25例（10.6%）报告既往未诊断为阻塞性肺病。尽管有共识指南的诊断建议，但COPD和哮喘之间的诊断混淆似乎很常见。需要提高对这两种情况之间差异的认识，以促进最佳的患者管理和治疗。
Chronic obstructive pulmonary disease ( COPD) is often misdiagnosed as asthma, leading to inappropriate treatment and suboptimal patient outcomes. As part of a prospective study of patients with a history consistent with obstructive lung disease, we compared prior diagnostic labels with a study diagnosis based on spirometric results. We enrolled persons 40 years of age or older with prior diagnoses or medications consistent with obstructive lung disease. Patients were recruited via random mailing to primary care practices in Aberdeen, Scotland, and Denver, Colorado. Prior diagnoses of chronic bronchitis or emphysema ( CBE) and asthma were reported by the subjects. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined using post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.70. Spirometric examination was complete in 597 patients, of whom 235 (39.4%) had a study diagnosis of COPD. Among subjects with a spirometry-based study diagnosis of COPD, 121 (51.5%) reported a prior diagnosis of asthma without concurrent CBE diagnosis, 89 (37.9%) reported a prior diagnosis of CBE, and 25 (10.6%) reported no prior diagnosis of obstructive lung disease. Despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment.