Agreement between obstructive airways disease diagnoses from self-report questionnaires and medical records

Objective: To evaluate agreement between self-reported obstructive airways disease (OAD) diagnoses of asthma, bronchitis, and chronic obstructive pulmonary disease (COPD)/emphysema obtained from the New York City Fire Department (FDNY) monitoring questionnaires with physician diagnoses from FDNY medical records. Method: We measured sensitivity, specificity, and agreement between self-report and physician OAD diagnoses in FDNY members enrolled in the World Trade Center (WTC) monitoring program who completed a questionnaire between 8/2005―1/2012. Using logistic models, we identified characteristics of those who self-report a physician diagnosis that is also reported by FDNY physicians. Results: 20.3% of the study population (N = 14,615) self-reported OAD, while 15.1% received FDNY physician OAD diagnoses. Self-reported asthma had the highest sensitivity (68.7%) and overall agreement (91.9%) between sources. Non-asthma OAD had the lowest sensitivity (32.1%). Multivariate analyses showed that among those with an OAD diagnosis from FDNY medical records, inhaler use (OR = 4.90, 95% CI = 3.84-6.26) and respiratory symptoms (OR = 1.55 [95% CI = 1.25―1.92]―1.77 [95% CI = 1.37―2.27]) were associated with self-reported OAD diagnoses. Conclusion: Among participants in the WTC monitoring program, sensitivity for self-reported OAD diagnoses ranges from good to poor and improves by considering inhaler use. These findings highlight the need for improved patient communication and education, especially for bronchitis or COPD/emphysema.