COPD diagnosis and treatment in the primary care setting: adherence to GOLD guidelines is far away

Abstract

Introduction: Diagnosis and treatment of COPD is not always consistent with GOLD guidelines especially in the primary care setting. Estimation of COPD underdiagnosis rate, overdiagnosis and overtreatment is the aim of the present study.

Methods: Participants in the present cross-sectional observational study were subjects of the general population, >40-year-old, current and former smokers (at least 10 pack-years) in primary care centers of northern Greece. Study period was 1/1/2012 to 31/12/2019. Exclusion criteria were a previous medical diagnosis of bronchial asthma or other chronic pulmonary diseases.

Results: We examined 5,226 subjects (mean age: 58.2±12.7 years, 61.5% males, current smokers: 56.2%) of whom 564 (10.8%) had respiratory symptoms and spirometry that confirmed the diagnosis of COPD. Patients with underdiagnosis of COPD were 300/564 (53.2%). Overdiagnosis was detected among 461 subjects (8.8%). None of them had a previous official spirometry test.

Patients: with correct diagnosis who were treated with long acting bronchodilators (one or two) plus ICS were 164/264 (62%) while 228/264 (86.4%) of them should be treated only with long-acting bronchodilators (GOLD A+B). Apart from overtreatment we found that 322/461 (69.8%) of those with overdiagnosis were treated with long acting bronchodilators plus ICS while they had normal spirometry.

Conclusions: More than 50% of the patients with COPD were underdiagnosed, COPD patients were overtreated and subjects with respiratory symptoms in the primary care setting are incorrectly diagnosed and treated as severe COPD