Diagnostic instability in patients with COPD

Objective: COPD is a quite common chronic respiratory tract disease and it has huge personal and social effects. This disease is a significant public health problem all over the world. Recent studies pointed out that COPD is not a disease which is necessarily progressive and irreversible. The aim of this study is to investigate the diagnostic instability in patients with COPD (changing into pb FEV1/FVC > 70%) and the factors that are effective on this situation. Material and method: Hospital Registration System (Enlil HBYS) was checked and it was found that 855 patients were diagnosed COPD in Çukurova University Faculty of Medicine Balcalı Hospital Chest Diseases Department between 2012 and 2014 with COPD. Their first application files were evaluated in the years of 2019-2020 and 358 of them who were diagnosed with definite COPD were included in the study. 497 patients who did not have post bronchodilator PFT, who had reversible obstructive PFT, who did not have any PFT, who had normal PFT, who had diagnosis of asthma-COPD overlap syndrome, whose PFT was restrictive, who had diagnosis of interstitial lung disease and who had bronchiectasis history were excluded from the study. 358 patients with definite diagnosis of COPD were invited to the clinic for the final evaluation. However, the patients whose mobile phones were switched off (n=82), who refused to come to the clinic for the final evaluation (n=53) and who became exitus (n=64) could not be included in the study. As a conclusion, 159 patients who were diagnosed with definite COPD in their first application and who came to the clinic for the final evaluation were investigated. The collected data were analysed and evaluated using the SPSS 23.0 package program. Results: Of the 159 patients included in the study, 81.8% were male and 18.9% were female; the average age of the patients was 60.6 ± 8.6 years during their first application. The patients were re-evaluated an average of 6.3 ± 0.5 years after the first application. Diagnostic instability was observed in 19 (11.9%) of 159 patients. It was seen that smoking rate of the patients decreased between their first application and final evaluation. On the other hand, it was determined that the rate of asymptomatic patients increased significantly. It was also found that the gender of female, high BMI, lack of comorbidity, educational level of university or higher, being in the phase of low GOLD spirometric in the first application were in correlation with the increase in the diagnostic instability prevalence. The multi-variable regression analysis revealed that being a female and having an educational level of university or higher resulted in a severe increase in the diagnostic instability prevalence. In this study, it was concluded that more than 50% of patients may change the initial GOLD spirometric stage and nearly 30% of the may regression the initial GOLD spirometric stage. Conclusions: In our study, we found that in a portion of copd patients, air flow obstruction was recovered by the time, in other words a diagnostic instability has developed, but in an other portion of COPD patients, spirometric stage of COPD had regressed according to initial GOLD spirometric stage. These findings support that it is not always acceptable that COPD is both progressive and deteriorated by the time. In conclusion, we argue that prospective studies with larger groups will reveal the dimensions of diagnostic instability and the factors that are effective on the change and will contribute to the solution of this significent public health problem. Key words: COPD, Diagnosis, Diagnostic instability