Chest
Clinical InvestigationsCOPDGender Bias in the Diagnosis of COPD
Section snippets
Study Design
We devised one hypothetical case summary to present to primary-care physicians for their review and man agement. The summary described a middle-aged former smoker (of approximately 40 pack-years consumption) who presented with morning cough persisting for 4 years and worsening intermittently following viral respiratory tract infections. For 3 years, the patient had been troubled by breathlessness on moderate exertion. On physical examination, the only abnormal finding was the presence of
Physicians Surveyed
We surveyed a random sample of 192 primary-care physicians (96 American and 96 Canadian; 154 men and 38 women). In the United States, interviews were conducted in the following geographic areas (major urban center and surrounding nonurban region): Chicago, San Francisco, Seattle, Houston, Denver, Long Island, and Atlanta. In Canada, interviews were conducted in the following geographic areas (major urban center and surrounding nonurban region): Toronto, Montreal, Vancouver, Calgary, Winnipeg,
Discussion
Our data show that many primary-care physicians in North America are reluctant to consider the diagnosis of COPD, even when confronted by a middle-aged former smoker with chronic cough, dyspnea, and wheezes on physical examination. Moreover, they are less likely to make the diagnosis of COPD in women than in men, a diagnostic bias that is eliminated by the presentation of compatible spirometric data. Regrettably, only a minority of primary-care physicians would consider requesting spirometry in
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The authors received a research grant-in-aid from Boehringer Ingelheim Canada Ltd and Boehringer Ingelheim Pharmaceuticals Inc.