Despite the well-established population burden of chronic obstructive pulmonary disease (COPD), an adequate diagnosis remains a challenge for clinicians and healthcare managers. Recent epidemiological studies are consistently reporting high figures of inadequate diagnosis.
Interestingly, although the term ‘underdiagnosis’ is well accepted and understood, the opposite concept is referred to with a range of terms, for example, overdiagnosis, improper diagnosis, or misdiagnosis. However, they are not synonymous terms, and refer to different situations, with different potential consequences for patients.1 A unified consensus definition is needed for the different clinical scenarios.
The consequences of this underdiagnosis are obvious and directly affect patients not receiving adequate health care for their condition,2 or not controlling a disease that may impact on other comorbidities.3 Additionally, underdiagnosis may impact healthcare resources, because the therapeutic management would not be focused on the right disease. The consequences of this incorrect or wrong diagnosis impact several domains, with many patients receiving pharmacological treatment that is not needed and has a potential for drug-related adverse effects, giving health services to the wrong patients, subjecting them to tests, labelling them as sick or at-risk, telling them to modify their daily living habits, or insisting on monitoring them regularly. Last but not least, it also impacts on the health system, leading to potential extra costs.4,5
The issue of overdiagnosis and overtreatment of COPD was recently highlighted in a large ‘real-world’ study conducted in primary care in the UK, where only two-thirds of diagnoses …