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Inaccurate diagnosis of COPD: the Welsh National COPD Audit

COPD is the leading cause of poor health, disability and mortality in the UK. In Wales, the prevalence of COPD is 2.2% and rates of hospital admissions and mortality due to COPD are higher than the UK average.

Making an accurate diagnosis of COPD is challenging and spirometry should be used to confirm diagnosis and demonstrate persistent airflow obstruction. Previous studies have demonstrated that when COPD is not confirmed by post bronchodilator spirometry, diagnosis accuracy may be as low as 50%. Misdiagnosis may lead to incorrect management of a patient’s respiratory symptoms, which can have an impact on their quality of life.

Data from the Welsh National COPD Primary Care Audit were used to evaluate the clinical symptoms and management of patients with spirometry incompatible with COPD.

The Welsh National COPD Primary Care Audit collected data from 48,105 patients across 280 General practices in Wales between January 2014 and March 2015. Only patients on the register with recorded post-bronchodilator FEV1/FVC were included in this analysis (n=8957). 25% of the sample had spirometry incompatible with COPD diagnosis (FEV1/FVC ratio ≥0.70), who were compared with the remaining 75% of patients with compatible spirometry (FEV1/FVC <0.70).

Patients with incompatible spirometry were more likely to be never-smokers and female, and on average had better mean FEV1 and higher body mass index scores. On measures of respiratory symptoms, groups were similar for breathlessness scores and exacerbation frequency. Asthma co-diagnosis was similar in both groups and patients in the groups were equally likely to be taking long-acting beta-agonists and ICS. However, patients with incompatible spirometry were less likely to receive a combination of both medication types or long-acting muscarinic agonists. Moreover, the researchers observed that spirometry was misinterpreted in around a quarter of cases, which implies an estimated 16,000 misdiagnoses across the whole of Wales, if extrapolated.

Among the strengths of this study was the insight into the real-world diagnosis and management of COPD on a national level. The study does have its limitations: notably the authors not having access to information on patients’ comorbidity diagnoses, which may have provided alternative explanations for clinical features of patients with incompatible spirometry.

The authors conclude that the poor documentation of spirometry and incorrect interpretation of spirometry results leads to a significant proportion of COPD patients receiving inaccurate diagnoses. They also call for healthcare providers and commissioners to increase their efforts to improve the accuracy of COPD diagnosis in primary care because there are significant costs to the NHS that will continue if the problem remains unsolved.

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