HOW TO AVOID UNDERDIAGNOSED ASTHMA CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

The prevalence of asthma and chronic obstructive pulmonary disease (CO PD) is rising in most countries, including the Netherlands. It has bee n suggested that a majority of these cases of (self-reported) symptoms related to asthma/COPD are not diagnosed in general practice. We comp ared a population screening for underdiagnosed asthma/COPD with a high -risk approach by a questionnaire form with specified questions about asthma/COPD-related symptoms. A case-controlled study including a reco rd review was performed of cases and controls. The results of a popula tion screening were used to classify patients as (a) asthma/COPD, (b) at risk for asthma/COPD, or (c) no asthma/COPD. Eleven hundred fifty-f ive patients were screened. One hundred fifty-five patients reported p revious asthma/COPD-related care (cases). The difference between numbe r of cases and controls in asthma/COPD diagnosis was chosen as main ou tcome measure. The population screening revealed 85 subjects with a di agnosis of asthma/COPD and 154 subjects with an increased risk. Ninete en diagnoses could be made in cases, and eight diagnoses in controls. The chart review showed that only seven cases and two controls were kn own to the general practitioner. From this study it can be concluded t hat in order to reduce the number of un- and underdiagnosed patients, all listed patients in general practice should be screened. However, i f screening of all patients is not feasible, active case finding by as king a few questions about shortness of breath or wheezing to all pati ents in the group of listed individuals is recommended.