Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis

Abstract

This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3-46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6-55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9-72.6%) and 36.3% (17.8-57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.

Keywords: chronic obstructive pulmonary disease (COPD); meta-analysis; overdiagnosis; overtreatment.

Figure 1

PRISMA flowchart. From: Page MJ, McKenzie JE, Bossuyt PM, et al. “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews” [11].

Figure 2

Proportion meta-analysis of overdiagnosis among subjects with clinical diagnosis of COPD, according to GOLD definition [8,16,17,18,21,22,23,24,25,26,27,28,29,30,31,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56]. ES = Effect Size (% of overdiagnosis); CI: Confidence Interval; COPD: Clinically Diagnosed Chronic Obstructive Pulmonary Disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; I²: level of heterogeneity.

Figure 3

Proportion meta-analysis of overdiagnosis among subjects with clinical diagnosis of COPD, according to LLN definition [19,20,22,32,37,40,43,44,46,49]. ES = Effect Size (% of overdiagnosis); CI: Confidence Interval; COPD: Clinically Diagnosed Chronic Obstructive Pulmonary Disease; LLN: Lower limit of normal; I²: level of heterogeneity.

Figure 4

Proportion meta-analysis of overtreatment among overdiagnosed individuals, according to GOLD and LLN definition [8,19,20,23,25,26,39,46,50,51,53,54,55,56]. ES = Effect Size (% of overtreatment); CI: Confidence Interval; COPD: Clinically Diagnosed Chronic Obstructive Pulmonary Disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; LLN: Lower limit of normal; I²: level of heterogeneity.