Background
There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012.

Methods
A false positive diagnosis of COPD was considered when participants reported a doctor’s diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7).

Results
Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of “chronic bronchitis” or “emphysema” (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication.

Conclusions
False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.

Lea Sator, Andreas Horner , Michael Studnicka , Bernd Lamprecht , Bernhard Kaiser , Mary Ann McBurnie , A Sonia Buist , Luisa Gnatiuc , David M Mannino , Christer Janson , Eric D Bateman , Peter Burney , NanShan Zhong , Shengming Liu , Jiachun Lu , Pixin Ran , Dali Wang , Jingping Zheng , Yumin Zhou , Ali Kocabaş , Attila Hancioglu , Ismail Hanta , Sedat Kuleci , Ahmet Sinan Turkyilmaz , Sema Umut , Turgay Unalan , Torkil Dawes , Eric Bateman , Anamika Jithoo , Desiree Adams , Edward Barnes , Jasper Freeman , Anton Hayes , Sipho Hlengwa , Christine Johannisen , Mariana Koopman , Innocentia Louw , Ina Ludick , Alta Olckers , Johanna Ryck , Janita Storbeck , Thorarinn Gislason , Bryndis Benedikdtsdottir , Kristin Jörundsdottir , Lovisa Gudmundsdottir , Sigrun Gudmundsdottir , Gunnar Gundmundsson , ENizankowska-Mogilnicka , Jakub Frey , Rafal Harat , Filip Mejza , Pawel Nastalek , Andrzej Pajak , Wojciech Skucha , Andrzej Szczeklik , Magda Twardowska , Tobias Welte , Isabelle Bodemann , Henning Geldmacher , Alexandra Schweda-Linow , Amund Gulsvik, , Tina Endresen , Lene Svendsen , Wan C Tan , Wen Wang , John Cain , Rebecca Copeland , Dana Hazen , Jennifer Methvin , Renato B Dantes , Lourdes Amarillo , Lakan U Berratio , Lenora C Fernandez , Norberto A Francisco , Gerard S Garcia , S Teresita , Luisito F Idolor , Sullian S Naval , Thessa Reyes , Camilo C Roa Jr , Ma Flordeliza Sanchez , Leander P Simpao , Christine Jenkins , Guy Marks , Tessa Bird , Paola Espinel , Kate Hardaker , Brett Toelle , Peter GJ Burney , Caron Amor , James Potts , Michael Tumilty , Fiona McLean , EFM Wouters , GJ Wesseling , Cristina Bárbara , Fátima Rodrigues , Hermínia Dias , João Cardoso , João Almeida , Maria João Matos , Paula Simão , Moutinho Santos , Reis Ferreira , Inga Sif Olafsdottir , Katarina Nisser , Ulrike Spetz-Nyström , Gunilla Hägg , Gun-Marie Lund , Rain Jõgi , Hendrik Laja , Katrin Ulst , Vappu Zobel , Toomas-Julius Lill , Parvaiz A Koul , Sajjad Malik , Nissar A Hakim , Umar Hafiz Khan , Rohini Chowgule , Vasant Shetye , Jonelle Raphael , Rosel Almeda , Mahesh Tawde , Rafiq Tadvi , Sunil Katkar , Milind Kadam , Rupesh Dhanawade , Umesh Ghurup , Imed Harrabi , Myriam Denguezli , Zouhair Tabka , Hager Daldoul , Zaki Boukheroufa , Firas Chouikha , Wahbi Belhaj Khalifa , Camilo C Roa , Fernando G Ayuyao , Cecil Z Tady , Daniel T Tan , Sylvia Banal-Yang , Vincent M Balanag Jr , Maria Teresita N Reyes , Sanjay Juvekar , Siddhi Hirve , Somnath Sambhudas , Bharat Chaidhary , Meera Tambe , Savita Pingale , Arati Umap , and Archana Umap. "Overdiagnosis of COPD in subjects with unobstructed spirometry: a BOLD analysis." Chest 156, no. 2 (2019): 277-288.