Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population

Figures & data

Table 1 Characteristics of patients referred for spirometry

Characteristics	All patients (n = 80)	Spirometry results
		No obstruction (n = 34)	Reversible obstruction (n = 18)	Nonreversible obstruction (n = 28)
Age, years (mean ± standard deviation)	52.9 ± 7.7	50.5 ± 7.9	51.7 ± 6.9	56.7 ± 6.8
Male (n, %)	32 (40.0)	12 (35.3)	10 (55.6)	10 (35.7)
Insurance status (n, %)
Self-pay	57 (71.3)	22 (64.7)	17 (94.4)	18 (64.3)
Medicaid	12 (15.0)	7 (20.6)	1 (5.6)	4 (14.3)
Private insurance	1 (1.3)	0 (0.0)	0 (0.0)	1 (3.6)
Medicare	10 (12.5)	5 (14.7)	0 (0.0)	5 (17.9)
Race (n, %)
Caucasian	71 (88.8)	29 (85.3)	17 (94.4)	25 (89.3)
African American	8 (10.0)	5 (14.7)	1 (5.6)	2 (7.1)
Native American	1 (1.3)	0 (0.0)	0 (0.0)	1 (3.6)
Smoking history (pack years ± standard deviation)	37.9 ± 26.1	28.3 ± 21.7	42.2 ± 23.0	46.8 ± 29.5
Inhalers (n, %)
LABA and ICS	46 (57.5)	17 (50.0)	12 (66.7)	17 (60.7)
LABA	5 (6.3)	2 (5.9)	1 (5.6)	2 (7.1)
Beta2 agonist	73 (91.3)	30 (88.2)	18 (100.0)	25 (89.3)
Anticholinergic and beta2 agonist	11 (13.8)	5 (14.7)	2 (11.1)	4 (14.3)
Anticholinergic (short)	5 (6.3)	3 (8.8)	1 (5.6)	1 (3.6)
Anticholinergic (long)	44 (55.0)	19 (55.9)	9 (50.0)	16 (57.1)
Any anticholinergic inhalers	55 (68.8)	26 (76.5)	10 (55.6)	19 (67.9)
Any inhaler	80 (100.0)	34 (100.0)	18 (100.0)	28 (100.0)

Abbreviations: ICS, inhaled corticosteroids; LABA, long acting beta2 agonist.

Figure 1 Spirometry findings of patients with previous chronic obstructive pulmonary disease or anticholinergic inhalers (n = 80).

Table 2 Comparison of studies that highlighted the magnitude of chronic obstructive pulmonary disease over diagnosis

Author	Year	Country	Sample size	Setting	Rate of COPD over diagnosis	Variables associated with COPD over diagnosis
Walters et al^Citation7	2011	Australia	341	Ambulatory practices	31%	Higher BMI and self-reported allergic rhinitis or hay fever
Buffels et al^Citation9	2012	Belgium	312	Family medicine teaching practices	28.6%	Not done
Melbye et al^Citation21	2011	Norway	376	General office practices	25.8%	Not reported
Jones et al^Citation22	2008	United Kingdom	580	Primary care practices	27.2%	Not reported
Sichletidis et al^Citation23	2007	Greece	319	Primary care centers	49.8%	Not done
Tinkelman et al^Citation10	2006	Scotland-US	597	Primary care centers	51.6%	Not reported
Ghattas et al	2013	US	80	Primary care practice	42.5%	Not reported

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease.

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