Chest
Original ResearchDiagnostic Labeling of COPD in Five Latin American Cities
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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2021, The LancetCitation Excerpt :Although tobacco smoking remains an important risk factor for airway obstruction in LMICs, between a third to a fifth of cases in LMICs occur in people who have never smoked, and a substantial proportion of these cases are probably related to biomass use for cooking and heating, especially in women.72–76 High levels of under-diagnosis and misdiagnosis of COPD are observed in LMICs,77,78 and data from national and international COPD surveys suggest that more than 80% of COPD cases identified on spirometry are undiagnosed within routine clinical care.79 Unsurprisingly, individuals with mild disease and without a history of exacerbations or admissions are less likely to have a diagnosis, but ethnicity, educational status, and absence of contact with health services also emerge as risk factors for under-diagnosis, suggesting that broader socioeconomic determinants are also important.77–79
Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis
2019, ChestCitation Excerpt :However, there are only a limited number of publications dealing with COPD overdiagnosis, and most of these studies conclude that overdiagnosis is a consequence of the definition of airflow limitation.12,24 The population-based PLATINO Study used the same protocol as the BOLD Study and demonstrated a 63.7% rate of false positive COPD, similar to our results (61.9%).8 False positive COPD may be a consequence of relying on symptoms for diagnosis, poor quality control of spirometry, or recording only pre-BD values and using the fixed ratio (FEV1/FVC < 0.7) rather than the lower limit of normal to define airflow limitation.
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.