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Diagnostic accuracy of respiratory diseases in primary health units
Rev Assoc Med B ras 2014; 60(6):599-612 599
Review article
Diagnostic accuracy of respiratory diseases in primary health units
Bruno Piassi de São José1*, Paulo A ugusto Moreira Camargos2, Álvaro Augusto Souza da Cruz F ilho3, Ricardo de Amorim Corrêa4
1Master and Doctoral student of medicine - Postgraduate degree in Infectology and Tropical Medicine, Federal University of Minas Gerais Medical School - Physician at the Hospital das Clínicas -UFMG Pneumology
Outpatient Clinic, Belo Horizonte, MG, Brazil
2Visiting Professor at the Pediatric Department - UFMG Medical School, Belo Horizonte, MG, Brazil
3ProAr – Center for Excellence in Asthma, Federal University of Bahia, Salvador, BA, Brazil
4Adjunct Professor IV- UFMG Medical School, Belo Horizonte, MG, Brazil
Summary
Study conducted at the Post-Graduation
Program of Infectology and Tropical
Medicine, Medical School, Federal
University of Minas Gerais
Belo Horizonte, MG
Article received: 3/8/2014
Accepted for publication: 3/24/2014
*Correspondence:
Address: Rua Nunes Vieira 304/1303,
Santo Antonio
Postal Code: 30350-120
Belo Horizonte – MG
Conflict of interest: none
Respiratory diseases are responsible for about a fifth of all deaths worldwide and
its prevalence reaches 15% of the world population. Primary health care (PHC)
is the gateway to the health system, and is expected to resolve up to 85% of health
problems in general. Moreover, little is known about the diagnostic ability of ge-
neral practitioners (GPs) in relation to respiratory diseases in PHC. This review
aims to evaluate the diagnostic ability of GPs working in PHC in relation to
more prevalent respiratory diseases, such as acute respiratory infections (ARI),
tuberculosis, asthma and chronic obstructive pulmonary disease (COPD). 3,913
articles were selected, totaling 30 after application of the inclusion and exclu-
sion criteria. They demonstrated the lack of consistent evidence on the accuracy
of diagnoses of respiratory diseases by general practitioners. In relation to asth-
ma and COPD, studies have shown diagnostic errors leading to overdiagnosis
or underdiagnosis depending on the methodology used. The lack of precision
for the diagnosis of asthma varied from 54% underdiagnosis to 34% overdiag-
nosis, whereas for COPD this ranged from 81% for underdiagnosis to 86.1% for
overdiagnosis. For ARI, it was found that the inclusion of a complementary test
for diagnosis led to an improvement in diagnostic accuracy. Studies show a low
level of knowledge about tuberculosis on the part of general practitioners. Ac-
cording to this review, PHC represented by the GP needs to improve its ability
for the diagnosis and management of this group of patients constituting one of
its main demands.
Keywords: respiratory tract diseases, primary health care, diagnosis, general
practitioners, review.
Introduction
According to the World Health Organization (WHO), 20%
of the 59 million annual deaths by all causes are due to
respiratory tract diseases.1,2 Among these, acute respira-
tory infections (ARI) occupy third place (3.6 million deaths;
6.1% of the total), while chronic obstructive pulmonary
disease (COPD) occupies fourth place, with 3.28 million
deaths (5.8% of the total), and will reach third place by
2030 according to projections.3-5
More than a billion people worldwide - 15% of the
global population - suffer from some kind of chronic res-
piratory disease, with half affected by one of the two most
prevalent conditions: asthma (235 million) 6or COPD
(210 million).7 Owing to this, around a third of appoint-
ments at primary health care (PHC) units worldwide are
due to respiratory diseases.1
Among the difficulties encountered in PHC in rela-
tion to this group of diseases, we can mention impreci-
sion in the diagnosis of asthma and COPD 8-10 and exces-
sive prescription of antibiotics for the treatment of acute
respiratory diseases.1,11,12 In general, little is known about