Gender bias in the diagnosis of COPD

Background: COPD is thought to be more prevalent among men than women, a fi nding usually attributed to higher smoking rates and more frequent occupati onal exposures of significance for men. However, smoking prevalence has inc reased among women and there is evidence that women may be more susceptible to the adverse pulmonary function effects of smoking than men. There may a lso be underdiagnosis and misdiagnosis of COPD in both sexes because object ive measures of lung function are underused, Objectives: We undertook the present study to determine if there is gender bias in the diagnosis of COPD, such that women are less likely than men to receive a diagnosis of COPD, We also attempted to determine if underuse of I;ng function measurements was a factor in any bias detected. Methods: We surveyed a random sample of 192 primary-care physicians (96 Ame rican and 96 Canadian; 154 men and 38 women) using a hypothetical case pres entation and a structured interview. The case of cough and dyspnea in a smo ker was presented in six versions differing only in the age and sex of the patient. After presentation of the history and physical findings, physician s were asked to state the most probable diagnosis and to choose the diagnos tic studies needed, Physicians were then presented with spirometric finding s of moderate or severe obstruction without significant bronchodilator resp onse, and the questions repeated. Finally, the negative outcome of an oral steroid trial was described. Results: Initially, COPD was given as the most probable diagnosis significa ntly more often for men than women (58% vs 42%; p < 0,05), The likelihood o f a COPD diagnosis increased significantly and initial differences between sexes decreased as objective information was provided. After spirometry, CO PD diagnosis rates for men and women were 74% vs 66% (p = not significant); after the steroid trial 85% vs 79% (p = not significant). Only 22% of phys icians would have requested spirometry after the initial presentation, Conclusions: In North America, primary-care physicians underdiagnose COPD, particularly in women. Spirometry reduces the risk of underdiagnosis and ge nder bias but is underused.