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Overdiagnosis of COPD in Unobstructed Spirometry

CHEST; ePub 2019 Jan 31; Sator, et al

In a recent analysis of subjects with unobstructed spirometry, false positive chronic obstructive pulmonary disease (COPD) was common, with the potential to expose this population to possible adverse effects of respiratory medication. Researchers described the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationships with overtreatment across 23 population samples in 20 countries participating in the BOLD study from 2003-2012. They found:

  • Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD.
  • Post-bronchodilator spirometry was unobstructed in 569 (61.9%) subjects—false positive COPD.
  • A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%) in a subgroup analysis.
  • The site-specific prevalence of false positive COPD varied significantly from 1.9% in low-middle income countries to 4.9% in high income countries.
  • Overdiagnosis was more common among women.


Sator L, Horner A, Studnicka M, et al. Overdiagnosis of COPD in subjects with unobstructed spirometry—a BOLD analysis. [Published online ahead of print January 31, 2019]. CHEST. doi:10.1016/j.chest.2019.01.015.