Misdiagnosis Among Frequent Exacerbators of Clinically Diagnosed Asthma and COPD in Absence of Confirmation of Airflow Obstruction
from By Vipul Jain, MD, MS, University of California San Francisco, Fresno
Clinical diagnosis of Severe Asthma and COPD is often flawed by lack of objective confirmation of airflow obstruction. Although misdiagnosis has been reported in stable disease, data are nonexistent in frequent exacerbators, a subset that might be expected to have definitive diagnoses. This study investigates misdiagnosis and its predictors in frequent exacerbators of severe asthma and COPD.
Frequent exacerbators of asthma and COPD (n=333) had a mean annual exacerbation rate of 3.4 per year. All patients underwent a rigorous diagnostic algorithm with systematic evaluations for alternative diagnoses in absence of airflow obstruction, over a follow-up period of 10 + 6 months. Two independent board certified pulmonologists reviewed composite data and ascertained final diagnosis. Multivariate logistic regression analyses were used to identify predictors of misdiagnosis.
Misdiagnosis was found in 26 percent (87 of 333) patients with final diagnoses of nonobstructive lung diseases. An additional 12 percent (41 of 333) of patients were found to have obstructive lung diseases other than asthma and COPD. Spirometry underutilization was an independent risk factor for misdiagnosis for both asthma and COPD.
Objective confirmation of airflow obstruction is essential to diagnosis of severe asthma and COPD. High rates of misdiagnosis prevail in patients with frequent exacerbations of clinically diagnosed severe asthma and COPD. Clinical diagnosis and management based on symptoms alone may be inadequate and perhaps unacceptable. Clinical diagnosis of obstructive lung disease should be used in conjunction with, but not in place of objective confirmation of airflow obstruction.
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