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Diagnostic Labeling of COPD in Five Latin American Cities^*

Carlos Tálamo, MD; Maria Montes de Oca, MD; Ron Halbert, MD; Rogelio Perez-Padilla, MD; José Roberto B. Jardim, MD; Adriana Muiño, MD; Maria Victorina Lopez, MD; Gonzalo Valdivia, MD; Julio Pertuzé, MD; Dolores Moreno, MD; Ana Maria B. Menezes, MD; for the PLATINO Team

^* From Universidad Central de Venezuela (Drs. Tálamo, Montes de Oca, and Moreno), Facultad de Medicina, Caracas, Venezuela; UCLA School of Public Health (Dr. Halbert), Los Angeles, CA; Institute of Respiratory Diseases (Dr. Perez-Padilla), Mexico City, Mexico; Federal University of São Paulo (Dr. Jardim), São Paulo, Brazil; Adriana, Universidad de la República (Drs. Muiño and Lopez), Facultad de Medicina, Montevideo, Uruguay; Pontifícia Universidad Católica de Chile (Drs. Valdivia and Pertuzé), Santiago de Chile, Chile; and Post-graduate Program in Epidemiology (Dr. Menezes), Federal University of Pelotas, Pelotas, Brazil. Members of the PLATINO Team are Maria Márquez, Pedro Hallal, Maria Blanco, Fernanda Rosa, and Aquiles Camelier.

Correspondence to: Carlos Tálamo, MD, Universidad Central de Venezuela, Facultad de Medicina, Hospital Universitario de Caracas, Cátedra de Neumonologia Piso 8, Caracas 1040, Venezuela; e-mail: carlostalamo{at}hotmail.com

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.

Key Words: COPD • diagnostic errors • prevalence • spirometry

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