Journal Information
Vol. 34. Issue 1.
Pages 9-13 (January 1998)
Share
Share
Download PDF
More article options
Vol. 34. Issue 1.
Pages 9-13 (January 1998)
Full text access
Estudio de la concordancia diagnóstica para las patologías asma y EPOC en pacientes ambulatorios
Diagnostic agreement for asthma and COPD in outpatients
Visits
3201
F. Baranda García*, V. Sobradillo Peña, N. Talayero Sebastián, M. Pérez de las Casas, C. Badiola Villa, E. Ciruelos Ayuso
Servicio de Neumología. Hospital de Cruces. Baracaldo. Vizcaya
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics

El objetivo del presente estudio ha sido evaluar la concordancia diagnóstica existente para las patologías asma y enfermedad pulmonar obstructiva crónica (EPOC), entre el diagnóstico clínico del neumólogo en el ambulatorio y el derivado de la aplicación de un protocolo diagnóstico que ha servido de referencia.

Se han incluido un total de 155 pacientes con diagnóstico ambulatorio de asma (80 pacientes) y EPOC (75 casos), con una edad media de 53 años (rango 18-84 años) de los que el 62% son varones.

Cada paciente ha sido estudiado con cuestionario CECA, espirometría basal y posbroncodilatación, registro del flujo máximo, test de provocación con histamina y estudio alérgico. Para evaluar la concordancia diagnóstica se ha empleado el método estadístico kappa.

La concordancia entre diagnósticos ambulatorios y el protocolo de referencia fue del 82%, con un valor de kappa de 0,63 (buena concordancia). El 18% del grupo quedaba sin un diagnóstico concluyente. De los 75 pacientes con diagnóstico ambulatorio de EPOC, el 78% no modificó su diagnóstico, el 12% cambió su diagnóstico a la categoría de asma, y un 9% de los pacientes quedó sin un diagnóstico definido. De los 80 enfermos con diagnóstico ambulatorio de asma, el 38% no modificó su diagnóstico, el 17,5% cambió su diagnóstico a EPOC, y el 27,5% quedó sin un diagnóstico concluyente. Las mayores dificultades se encontraban en los pacientes con asma que presentaban limitación crónica al flujo aéreo (LCFA).

Existe una buena concordancia entre los diagnósticos ambulatorios y el protocolo de referencia. La mayor modificación de diagnósticos está en los asmas que presentan LCFA. Un 18% de los pacientes permanece sin un diagnóstico concluyente.

Palabras clave:
Concordancia diagnóstica
Asma bronquial
EPOC

To evaluate agreement in diagnoses of asthma or chronic obstructive pulmonary disease (COPD) made by an outpatient clinic pneumologist and those indicated by applying a reference diagnostic protocol.

One hundred fifty-five patients diagnosed of asthma (n=80) or COPD (n=75), 62% of whom were men. Mean age was 53 years (range 18 to 84 years).

Data available for each patient included answers to the European Community for Coal and Steel questionnaire, spirometry before and after bronchodilation, peak flow measurements, and the results of histamine challenge and allergy testing. A kappa value was used to evaluate diagnostic agreement.

Agreement between diagnoses made by the outpatient pneumologist and that obtained using the protocol was 82%, with a kappa value of 0.63, indicating good agreement. No conclusive diagnoses could be made for 18% of the patients. For 78% of the 75 patients diagnosed of COPD in the outpatient clinic the diagnoses were not changed. The diagnoses of 12% were changed to asthma, and 9% were given no firm diagnoses. Of the 80 patients diagnosed of asthma in the outpatient clinic, the diagnoses of 38% were unchanged, those of 17,5% were changed to COPD, and 27,5% of the cohort was given no firm diagnosis. The greatest difflculties were encountered for patients with both asthma and chronic air flow limitation.

Agreement between outpatient clinic and reference protocol diagnoses is good. Diagnoses were most often changed for patients with both asthma and chronic air flow limitation. The proportion of patients for whom no diagnosis can be made is 18%.

Key words:
Diagnostic agreement
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
Full text is only aviable in PDF
Bibliografía
[1.]
J.A. Dosman, F.R. Gómez, C. Zhon.
Relationship between airway responsiveness and the development of chronic obstructive pulmonary disease.
Med Clin North Am, 74 (1990), pp. 561-569
[2.]
P.A. Vermiere, N.B. Pride.
A “splitting” look at chronic nonspecific lung disease (CNSLD): common features but diverse pathogenesis.
Eur Respir J, 4 (1991), pp. 490-496
[3.]
Sociedad Española de Neumología, Cirugía Torácica (SEPAR).
Normativa sobre diagnóstico y tratamiento del asma aguda y crónica.
Ediciones Doyma S.A, (1996),
[4.]
International Asthma Management Project Group.
International consensus report on diagnosis and treatment of asthma.
Eur Respir J, 5 (1992), pp. 601-641
[5.]
N.M. Siafakas, P. Vermier, M.B. Pride, P. Paoletti, J. Gibson, P. Howard, on behalf of the Task Force, et al.
Optimal assesment and management of chronic obstructive pulmonary disease (COPD).
Eur Respir J, 8 (1995), pp. 1.398-1.420
[6.]
K.F. Chang, B. Morgan, S.J. Keyes, P.D. Snashall.
Histamine dose- response relationships in asthmatic and normal subjects.
Am Rev Respir Dis, 126 (1982), pp. 849-854
[7.]
F. Baranda, V. Sobradillo, E. Ciruelos, V. Bustamante, M. Iríberrí.
Diferencias diagnósticas interambulatorias para EPOC y asma.
Arch Bronconeumol, 29 (1993), pp. 77
[8.]
A. Minette.
Questionnaire of the European Community for coal and Steel (ECCS) on respiratory symptoms, 1987-updating of the 1962 and 1967 questionnaires for studying chronic bronchitis and emphysema.
Eur Respir J, 2 (1989), pp. 165-177
[9.]
B. Burrows, M. Lebowitz, R.A. Barbee.
Respiratory disorders and allergy skin-test reaction.
Ann Intern Med, 84 (1976), pp. 134-139
[10.]
Grupo de trabajo de la, SEPAR., para la práctica de la espirometría en clínica.
Normativa para la espirometría forzada.
Ed. Doyma S.A, (1985),
[11.]
J.W. Yunginger, C.E. Reed, J. O’Connell, L.S. Melton, W.M. O’Fallon, M.D. Silverstein.
A communnity-based study of the epidemiology of asthma.
Am Rev Respir Dis, 146 (1992), pp. 888-894
[12.]
D.W. Cockcroft, D.N. Killian, J.J.A. Mellon, F.E. Hargreave.
Bronchial reactivity to inhaled histamine; a method and clinical survey.
Clin Allergy, 7 (1977), pp. 235-243
[13.]
P.L.P. Brand, H.A.M. Kerstjens, D.S. Postma, P.J. Sterk, Ph.H. Quanjer, H.J. Slniter, and the Dutch CNSLD study group, et al.
Long-term multicentre trial in chronic nonspecific lung disease: methodology and baseline assessment in adult patients.
Eur Respir J, 5 (1992), pp. 21-31
[14.]
D.L. Sacket, R.B. Haynes, P. Tugwell.
Clinical epidemiology. A basic Science for clinical medicine.
Little Brown, (1995), pp. 37
[15.]
P. Casal, E. Benlloch, F. Duce, M. Perpiña, C. Picado, J. Sanchís, et al.
Diagnóstico del asma: lo fundamental y lo accesorio.
Arch Bronconeumol, 29 (1993), pp. 1-7
[16.]
I. Gregg.
Epidemiological research in asthma: the need for a broad perspective.
Clin Allergy, 16 (1986), pp. 17-23
[17.]
R. Dodge, M.G. Cline, B. Burrows.
Comparisons of asthma, emphysema and chronic bronchitis diagnoses in a general population sample.
Am Rev Respir Dis, 133 (1986), pp. 981-986
[18.]
B. Burrows, J.W. Bloom, G.A. Traver, M.G. Cline.
The course and prognosis of different forms of chronic airways obstruction in a sample of the general population.
N Engl J Med, 317 (1987), pp. 1.309-1.314
[19.]
G.L. Snider.
Chronic bronquitis and emphysema disease:.
Text book of respiratory medicine, pp. 1.069-1.106
[20.]
S. Kersten, A.S. Rebuck.
Is the short-term response to inhaled B- adrenergic agonist sensitive or specific for distinguishing between asthma and COPD?.
Chest, 105 (1994), pp. 1.042-1.045
[21.]
N. Meslier, J.L. Racineux, P. Six, A. Lockhart.
Diagnostic value of reversibility of chronic airway obstruction to separate asthma from chronic bronchitis: a statistical approach.
Eur Respir J, 2 (1989), pp. 497-505
[22.]
O. Eliasson, A.C. DeGraff Jr..
The use of criteria for reversibility and obstruction to define patient groups for bronchodilator trials. Influence of clinical diagnosis, spirometric, and anthropometric variables.
Am Rev Respir Dis, 132 (1985), pp. 858-864
[23.]
A.S. Rebuck, J. Read.
Assessment and management of severe asthma.
Am J Med, 51 (1971), pp. 788-798
[24.]
N.B. Pride, P. Vermiere, L. Allegra.
Diagnostic lables applied to model case histories of chronic airflow obstruction. Responses to a questionnaire in 11 North American and European Countries.
Eur Respir J, 2 (1989), pp. 702-709
[25.]
P. Littlejohns, S. Ebrahims, H.R. Anderson.
Prevalence in diagnosis of chronic respiratory symptoms in adults.
Br Med J, 298 (1989), pp. 1.556-1.560
[26.]
A.J. Woolcock, S.D. Anderson, J.K. Peat, J.I. Du Toit, Y.G. Zhang, C.M. Smith, et al.
Characteristics of bronchial hyperresponsiveness in chronic obstructive pulmonary disease and in asthma.
Am Rev Respir Dis, 143 (1991), pp. 1.438-1.443
[27.]
G.H. Guyatt, M. Lefcoe, S. Walter, D. Cook, S. Troyan, L. Griffith, et al.
Interobserver variation in the computed tomographic evaluation of mediastinal lymph node size in patients with potentially resectable lung cancer. Canadian Lung Oncology Group.
Chest, 107 (1995), pp. 116-119
[28.]
L.M. Duncan, M. Berwick, J.A. Bruijn, H.R. Byers, M.C. Mihm, R.L. Barhill.
Histopathologic recognition and grading of dysplastic me- lanocytic nevi: an interobserver agreement study.
J Invest Dermatol, 100 (1993), pp. 318-321
[29.]
M. Guerra, F. García de Blas, M.T. Sanz, M.C. Morales, B. Pose.
Estudio de la concordancia interobservador en la lectura de la prueba de la tuberculina.
Enferm Infec Microbiol Clin, 11 (1993), pp. 531-535
Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?