Chest
Volume 131, Issue 1, January 2007, Pages 60-67
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Original Research
Diagnostic Labeling of COPD in Five Latin American Cities

https://doi.org/10.1378/chest.06-1149Get rights and content

Abstract

Background:COPD is a major worldwide problem with a rising prevalence. Despite its importance, there is a lack of information regarding underdiagnosis and misdiagnosis of COPD in different countries. As part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar study, we examined the relationship between prior diagnostic label and airway obstruction in the metropolitan areas of five Latin American cities (São Paulo, Santiago, Mexico City, Montevideo, and Caracas).

Methods:A two-stage sampling strategy was used in each of the five areas to obtain probability samples of adults aged ≥ 40 years. Participants completed a questionnaire that included questions on prior diagnoses, and prebronchodilator and postbronchodilator spirometry. A study diagnosis of COPD was based on airway obstruction, defined as a postbronchodilator FEV1/FVC < 0.70.

Results:Valid spirometry and prior diagnosis information was obtained for 5,303 participants; 758 subjects had a study diagnosis of COPD, of which 672 cases (88.7%) had not been previously diagnosed. The prevalence of undiagnosed COPD was 12.7%, ranging from 6.9% in Mexico City to 18.2% in Montevideo. Among 237 subjects with a prior COPD diagnosis, only 86 subjects (36.3%) had postbronchodilator FEV1/FVC < 0.7, while 151 subjects (63.7%) had normal spirometric values. In the same group of 237 subjects, only 34% reported ever undergoing spirometry prior to our study.

Conclusions:Inaccurate diagnostic labeling of COPD represents an important health problem in Latin America. One possible explanation is the low rate of spirometry for COPD diagnosis.

Section snippets

Methods and Materials

The Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study3was a population-based epidemiologic study conducted in five major Latin American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela). Complete details of the PLATINO methodology have been published.13Briefly, a two-stage cluster sampling method was used at each site in order to obtain a random sample of households. All adults ≥ 40 years old living

Results

Detailed descriptions of participation rates and the sample characteristics in the study, both total and for individual countries, have been published previously.3In summary, from a total of 6,711 eligible individuals, complete interviews were achieved in 5,571 subjects and spirometry was performed in 5,315 subjects. Both valid spirometry results and prior diagnosis information were available for 5,303 subjects.

There were 758 subjects with postbronchodilator FEV1/FVC < 0.7. The prior diagnostic

Discussion

The aim of the PLATINO study was to measure COPD prevalence in five Latin American cities. However, the study also offers an excellent opportunity to examine diagnostic patterns using a population-based sample. We observed a high prevalence of airway obstruction without a prior diagnostic label consistent with COPD: 12.7% of all subjects examined fell into this category. Among subjects with a study diagnosis of COPD, 88.7% of cases had not been previously diagnosed. However, a prior diagnosis

Acknowledgments

We would like to acknowledge the Asociación Latinoamericana de Tórax for its support to the PLATINO study. We would also like to acknowledge BOLD for their continuous participation in discussions of the PLATINO study and Boehringer Ingelheim GmbH for funding the study. The Advisory Committee included Bartolomé Celli, Sonia Buist, William Vollmer, and Roberto Rodríguez Roissin. The Executive Committee included Carlos Torres, Juan Luna, and Carmen Lisboa.

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Funding was provided by Boehringer Ingelheim GmbH.

Dr. Halbert is an employee of the Cerner Corporation, which provides consulting services to the pharmaceutical industry.

Dr. Menezes coordinated the PLATINO study. Dr. Perez-Padilla was responsible for spirometry quality control. Dr. Jardim was the principal investigator in São Paulo. Dr. Perez-Padilla was the principal investigator in Mexico City. Drs. Muiño and Lopez were principal investigators in Montevideo. Drs. Valdivia and Pertuzé were principal investigators in Santiago. Drs. Montes de Oca and Tálamo were principal investigators in Caracas. Dr. Halbert led the data analysis. Dr. Moreno contributed with ideas for the report. The article was revised and approved by all contributors.

None of the authors have any conflicts of interest to disclose.

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