Chronic obstructive pulmonary disease-missed diagnosis versus misdiagnosis

摘要

This article is part of a series of overdiagnosis looking at the risks and harms to patients of expanding definitions of disease and increasing use of new diagnostic technologies. By 2004 chronic obstructive pulmonary disease (COPD) was claimed to be the fourth most important cause of death worldwide, and its global prevalence and mortality are on the increase.2 Smoking accounts for about 75% of cases,3 but environmental exposures to tobacco smoke and other pollutants such as biomass fuels and occupational exposures may account for the remaining cases. COPD is a progressive disease, and in the later stages patients have frequent admissions to hospital, with over a third being readmitted in 30 days, contributing to an annual cost of ￡800m ({EUR}1bn; $1.24bn) in the UK. In the UK concern has been expressed that COPD is severely underdiagnosed, particularly among people with early stages of the disease who could benefit from preventive strategies. However, we argue that current diagnostic criteria are leading to overdiagnosis in some groups.