Misdiagnosis of COPD in middle-aged asthmatics in Nepal

Abstract

Background There are reports of misdiagnosis of COPD in elderly asthmatics in industrialized countries. In this region, COPD is frequently encountered in middle-aged subjects. We studied the proportions of asthma among 35–69 years-old-patients with COPD. Methods Total sixty consecutive patients, with history of chronic cough, dyspnoea and wheezing, who were being treated with a presumed diagnosis of COPD for at least 1 year and not receiving systemic or inhaled corticosteroids and whose postbronchodilator spirometry showed airflow limitation (FEV1/FVC 12% and >15% increase in FEV1 following bronchodilator or corticosteroids were considered as showing reversibility of airflow limitation and regarded as asthma with the above inclusion criteria. Findings The means (SE) of baseline FEV1 and FEV1/FVC % of the study population were 0.56 (0.04) and 45.2 (1.5) respectively. 86.7% were smokers. 12% or more increase in FEV1 was seen in 53.3% of patients following bronchodilator and in 60% following oral corticosteroids (p=0.46). Similarly >15% increase in FEV1 was seen in 48.3% of the patients following bronchodilator and in 55% following oral corticosteroids (p=0.47). The differences in sex and age distributions and in percentages of smokers in asthma and COPD groups were not significant. Interpretations Our results reveals that among 35–69 years-old-patients of presumed COPD not receiving inhaled corticosteroids in spite of being symptomatic, more than half have asthma. The study was conducted at the Department of Medicine, Bir Hospital, National Academy of Medical Sciences (NAMS),a national postgraduate hospital and referral center, Post Box: 3245, Kathmandu, Nepal.