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Concomitant diagnosis of asthma and COPD: a quantitative study in UK primary care

Francis Nissen, Daniel Morales, Hana Mullerova, et al.
Br J Gen Pract 2018;68(676):e775–e782

An accurate diagnosis of asthma and chronic obstructive pulmonary disease (COPD) is essential for the treatment of patients, reducing the frequency and severity of exacerbations and improving the overall quality of life.

The differential diagnosis of asthma and COPD relies on clinical presentation, triggering factors and demonstration of airflow obstruction. The existence of asthma–COPD overlap syndrome (ACOS) is controversial, with some guidelines, for example, classifying asthma with chronic airways obstruction as COPD. Studies looking at unblended populations of patients with asthma and patients with COPD keep the diseases distinct, and the prevalence of a concomitant diagnosis varies greatly in different studies.

The aim of this quantitative study in UK primary care was to quantify concomitant prevalence and to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.

UK electronic health records of diagnosed populations of only those patients with asthma and patients with COPD from two previous validation studies were used to define the prevalence of concomitant asthma and COPD.

Patients with validated asthma and patients with validated COPD were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and confirmed with GP questionnaires. Data for asthma were collected for two years from December 2013, and for eight years from January 2004 for COPD. Prevalence of concurrent asthma and COPD was based on CPRD coding, GP questionnaires and additional requested information.

The study found that concurrent asthma and COPD diagnosis affects a minority of patients with either asthma (14.8%) or COPD (14.5%). The conclusion is that asthma may be over-recorded in people with COPD in electronic health records.

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