Accuracy of COPD diagnosis in primary care in Knowsley, UK

Wat, Dennis; Sibley, Sarah

doi:10.1183/1393003.congress-2017.pa924

Cited by 2 publications

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“…Throughout the COVID19 pandemic spirometry ceased in primary care and patients have been diagnosed on the basis of clinical findings alone [ 27 ]. As a result, there is the potential for a new cohort of misdiagnosed patients and without encouragement to review their diagnoses, at annual monitoring review, they risk remaining misdiagnosed until reviewed by a specialist in secondary care or a primary care diagnostic hub [ 28 , 29 ]. Therefore, the retraining of primary care clinicians to be confident and competent with spirometry needs to be a priority.…”

Section: Discussionmentioning

confidence: 99%

Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study

Patel,

Smith,

Huntley

et al. 2024

PLoS ONE

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Background Within primary care there exists a cohort of patients misdiagnosed with Chronic Obstructive Pulmonary Disease (COPD). Misdiagnosis can have a detrimental impact on healthcare finances and patient health and so understanding the factors leading to misdiagnosis is crucial in order to reduce misdiagnosis in the future. The objective of this study is to understand and explore the perceived causes of COPD misdiagnosis in primary care. Methods A sequential mixed methods study, quantifying prevalence and features of patients misdiagnosed with COPD in primary care followed by a qualitative analysis to explore perceived causes of misdiagnosis. Quantitative data was collected for 206 patients identified as misdiagnosed with COPD within the INTEGR COPD study (NCT03482700). Qualitative data collected from 21 healthcare professionals involved in providing COPD care and 8 misdiagnosed patients who were recruited using a maximum variation purposive sampling. Results Misinterpretation of spirometry results was the prevailing factor leading to patients initially being misdiagnosed with COPD, affecting 59% of misdiagnosed patients in this cohort. Of the 99 patients who were investigated for their underlying diagnosis; 41% had normal spirometry and 40% had asthma. Further investigation through qualitative methodology uncovered reluctance to challenge historical misdiagnoses and challenges in differential diagnosis as the underlying explanations for COPD misdiagnosis in this cohort. Conclusions Patients historically diagnosed with COPD without spirometric evidence are at risk of remaining labelled and treated for COPD despite non-obstructive respiratory physiology, leading to a persistent cohort of patients misdiagnosed with COPD in primary care. The lack of spirometry services during and after the COVID19 pandemic in primary care risks adding to the cohort of misdiagnosed patients. Support from respiratory specialists can potentially help to reduce the prevalence of COPD misdiagnosis in primary care. Trial registration NCT03482700.

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Section: Discussionmentioning

confidence: 99%

Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study

Patel,

Smith,

Huntley

et al. 2024

PLoS ONE

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“…It has long been acknowledged that operator, patient and equipment factors are the most common reasons for inconsistent spirometry readings [ 13 , 14 ]. In primary care, the spirometry is usually performed by trained nurses, at the point of COPD diagnosis and, prior to April 2019, annually thereafter to detect the rate of decline in lung function.…”

Section: Discussionmentioning

confidence: 99%

An audit of COPD: diagnosis and management in general practice

2020

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IntroductionCOPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7.MethodsFrom November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count.ResultsWe assessed 1088 records. Median age was 70.9 years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV1/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of ≥0.7. In the patients with a ratio of ≥0.7, 259 (67%) out of 388 had an FEV1 <80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV1 % predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV1, EOS were examined in combination, they were highly significant predictors for exacerbations.ConclusionFEV1 maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV1. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention.

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Accuracy of COPD diagnosis in primary care in Knowsley, UK

Cited by 2 publications

References 0 publications

Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study

Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study

An audit of COPD: diagnosis and management in general practice

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