Challenges in the Diagnosis of Chronic Obstructive Pulmonary Disease

Abstract

readily adapt their lifestyles to offset diminished exercise capacity and rarely seek evaluation early in the disease. Cough, wheezing, sputum production, and shortness of breath are symptoms, which become increasingly more common as spirometric values of lung function decline. However, up to 21 % of patients with severe to very severe airflow limitation by spirometry describe no symptoms [3]. Even when symptoms arise, they are nonspecific, with a recent study showing that even when three or more of the common symptoms of COPD are present, they cannot discriminate between patient with or without airflow obstruction [4•]. Patients can also present with different complaints. Studies have shown that male patients with COPD present more commonly with complaints of cough and phlegm production, whereas female patients often note more dyspnea and decreased quality of life, even with lower pack years of tobacco use and similar lung function [5, 6]. Gender bias is also a barrier in women to the diagnosis of COPD, as demonstrated by a study where spirometry data improved an inherent gender bias seen when physicians were more likely to diagnose COPD in men than women, when both presented with similar symptoms and clinical characteristics [7, 8].