{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:45:55Z","timestamp":1787071555101,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The prevalence and healthcare burden of COPD are estimated to arise over the next years not only due to persistent tobacco consumption but also due to misdiagnosis of the disease. The present observational study among smokers and ex-smokers aims to assess the prevalence of COPD misdiagnosis (over and underdiagnosis) as well as the differences and similarities between patients with previous correct diagnosis of COPD and those with underdiagnosed disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We performed an observational cross-sectional study in four rural counties and in one of the primary health centers of the metropolitan city of Thessaloniki, Greece aiming estimate the prevalence of COPD and evaluate the differences between patients with diagnosed and underdiagnosed disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 5,239 participants were enrolled in the study, of whom 565 subjects (10.8%) fulfilled the clinical and spirometric criteria for the diagnosis of COPD according to GOLD guidelines. Notably, 264 patients had a previous correct diagnosis of COPD (46.7%), 301 patients were underdiagnosed (new cases) while 461 subjects had a previous false diagnosis of COPD (overdiagnosis). Patients with underdiagnosed COPD were younger and more frequently current smokers. In addition, they presented less frequently with clinically important respiratory symptoms estimated by specific questionnaires but on the contrary the percentages of single symptoms such as cough, phlegm, dyspnea and wheezing were not significantly different compared with those with correct prior COPD diagnosis. They also reported fewer comorbidities and they mostly had early-stage disease based on spirometry or medical history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>There is a noteworthy number of underdiagnosed and overdiagnosed cases of COPD among an unselected sample of the general population in northern Greece. Underdiagnosed patients with COPD are younger, usually current smokers but with early-stage disease compared with previously diagnosed subjects. National screening programs for high risk populations (current smokers with respiratory symptoms) in the primary care setting as well as GPs training on spirometry and COPD management should be planed as healthcare strategies in the near future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_1878_24","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T15:02:05Z","timestamp":1758639725000},"page":"3406-3411","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Diagnosed and underdiagnosed cases of COPD in the primary care setting: Differences and similarities"],"prefix":"10.4103","volume":"14","author":[{"given":"Ioanna","family":"Filippou","sequence":"first","affiliation":[{"name":"Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionisios","family":"Spyratos","sequence":"additional","affiliation":[{"name":"Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Tsiouprou","sequence":"additional","affiliation":[{"name":"Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diamantis","family":"Chloros","sequence":"additional","affiliation":[{"name":"Pulmonary Department, National Health System, G. Papanikolaou Hospital, Exohi, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionisia","family":"Michalopoulou","sequence":"additional","affiliation":[{"name":"Primary Care Center, Municipality of Thessaloniki, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Sichletidis","sequence":"additional","affiliation":[{"name":"Pulmonary Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"R1-20250924","article-title":"Chronic Obstructive Pulmonary Disease","year":"2022"},{"key":"R2-20250924","article-title":"Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (updated 2022)"},{"key":"R3-20250924","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1164\/rccm.201804-0621CI","article-title":"Under-diagnosis and over-diagnosis of chronic obstructive pulmonary disease","volume":"1989","author":"Diab","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"R4-20250924","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.rmed.2017.05.015","article-title":"Causes of misdiagnosis of chronic obstructive pulmonary disease:A systematic scoping review","volume":"129","author":"Hangaard","year":"2017","journal-title":"Respir Med"},{"key":"R5-20250924","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3399\/bjgp17X690389","article-title":"Overdiagnosis of COPD:Precise definitions and proposals for improvement","volume":"67","author":"Fern\u00e1ndez-Villar","year":"2017","journal-title":"Br J Gen Pract"},{"key":"R6-20250924","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.chest.2019.01.015","article-title":"Overdiagnosis of COPD in subjects with unobstructed spirometry:A BOLD analysis","volume":"156","author":"Sator","year":"2019","journal-title":"Chest"},{"key":"R7-20250924","doi-asserted-by":"crossref","first-page":"107347","DOI":"10.1016\/j.rmed.2023.107347","article-title":"Underdiagnosis and misclassification of COPD in Sweden-A Nordic Epilung study","volume":"217","author":"Axelsson","year":"2023","journal-title":"Respir Med"},{"key":"R8-20250924","doi-asserted-by":"crossref","first-page":"e0152266","DOI":"10.1371\/journal.pone.0152266","article-title":"COPD underdiagnosis and misdiagnosis in a high-risk primary care population in four Latin American Countries. A Key to enhance disease diagnosis:The PUMA study","volume":"11","author":"Casas","year":"2016","journal-title":"PLoS One"},{"key":"R9-20250924","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1378\/chest.13-0453","article-title":"Characteristics of undertreatment in COPD in the general population","volume":"144","author":"Ingebrigtsen","year":"2013","journal-title":"Chest"},{"key":"R10-20250924","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1378\/chest.125.3.892","article-title":"Prevalence of COPD in Greece","volume":"125","author":"Tzanakis","year":"2004","journal-title":"Chest"},{"key":"R11-20250924","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.3390\/jpm12121997","article-title":"Greek Guidelines for the Management of COPD, a proposal of a holistic approach based on the needs of the Greek Community","volume":"12","author":"Tzanakis","year":"2022","journal-title":"J Pers Med"},{"key":"R12-20250924","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1183\/20734735.0346-2018","article-title":"Under-and over-diagnosis of COPD:A global perspective","volume":"15","author":"Ho","year":"2019","journal-title":"Breathe"},{"key":"R13-20250924","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1183\/20734735.0354-2018","article-title":"Use of the terms \u201coverdiagnosis\u201dand \u201cmisdiagnosis\u201din the copd literature:A rapid review","volume":"15","author":"Thomas","year":"2019","journal-title":"Breathe"},{"key":"R14-20250924","doi-asserted-by":"crossref","first-page":"6","DOI":"10.4081\/monaldi.2005.651","article-title":"Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy","volume":"63","author":"Caramori","year":"2005","journal-title":"Monaldi Arch Chest Dis"},{"key":"R15-20250924","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.rmed.2018.08.006","article-title":"Accuracy of diagnosis of COPD and factors associated with misdiagnosis in primary care setting. 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