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Clinical Investigations: COPD |

Aging and Disability Affect Misdiagnosis of COPD in Elderly Asthmatics*: The SARA Study

Vincenzo Bellia; Salvatore Battaglia; Filippo Catalano; Nicola Scichilone; Raffaele Antonelli Incalzi; Claudio Imperiale; Franco Rengo
Author and Funding Information

*From the Istituto di Medicina Interna e Geriatria (Dr. Incalzi), Catholic University of Rome, Rome; Istituto di Medicina Generale e Pneumologia (Drs. Bellia, Battaglia, Catalano, and Scichilone), University of Palermo, Palermo; Fondazione S. Raffaele (Dr. Imperiale), Cittadella della Carità, Taranto; and Cattedra di Gerontologia e Geriatria (Dr. Rengo), Federico II University of Naples, Naples, Italy.

Correspondence to: Vincenzo Bellia, MD, FCCP, Istituto di Medicina Generale e Pneumologia, c/o Ospedale V. Cervello, via Trabucco 180, 90146 Palermo, Italy; e-mail: pneumopa@tin.it



Chest. 2003;123(4):1066-1072. doi:10.1378/chest.123.4.1066
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Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients.

Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions.

Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 ± 6.4 years (mean ± SD) were selected from the cohort of the Salute Respiratoria nell’Anziano (respiratory health in the elderly) study.

Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded.

Results: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred.

Conclusions: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma.

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