Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997?2001

Abstract

ObjectiveAsthma and COPD require different management strategies, but differentiation in primary care is difficult. This primary care support initiative observed the impact of spirometry and clinical assessment on the diagnosis of airway disease.Materials and methodsOf 61 191 patients aged ≥40 years being treated for respiratory conditions within 1003 UK primary care practices, 43 203 underwent a diagnostic review including standardized spirometric assessment. The proportion of patients in whom the diagnosis was changed by the additional information was determined. The relationship of various patient characteristics was compared with the baseline and review diagnoses and with any change in diagnosis.ResultsAsthma was initially diagnosed in 43% of patients, COPD in 35%, mixed disease in 9%, and other respiratory condition in 13%. Patients initially diagnosed with asthma, mixed disease, or another condition were more likely to have their diagnosis changed at review (54%, 46%, and 63%, respectively) than those initially diagnosed with COPD (14%). A change from asthma to COPD was associated with male gender, smoking, older age, and reduced lung function, the opposite being associated with a change from COPD to asthma.ConclusionIn this study, a clinical review supplemented by additional information including spirometry highlights apparent mislabeling of significant numbers of patients with chronic obstructive disease in general practice with significant implications for individual treatment and healthcare provision. This study shows that the addition of more clinical information can have a major effect on diagnostic tendency in patients with airway disease. An initial diagnosis of COPD seems less likely to change following review than an asthma diagnosis. While it is likely that greater information leads to a more accurate diagnosis, the differential effect of new information on diagnostic labeling highlights the insecurity of the diagnostic process in primary care in the UK.

The feasibility of recruiting patients with early COPD to a pilot trial assessing the effects of a physical activity intervention

“…33 Research has highlighted that the mislabelling of patients with COPD in primary care may have significant implications for individual treatment and healthcare provision. 34,35 As such, the inclusion of further pertinent information on practice registers may lead to a more accurate diagnosis of patients' disease characteristics. 34 A further 12 patients were also excluded prior to screening due to reasons including immobility, transportation issues, lack of smoking history and work commitments.…”

Case-finding options for COPD: results from the Burden of Obstructive Lung Disease Study

“…A lthough chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide and is increasing in prevalence, it is often underdiagnosed [1][2][3][4]. This underdiagnosis has important policy implications since appropriate management of COPD is known to decrease the risk of future exacerbations and hospitalisations and to improve health status, including symptoms and even exercise tolerance [5].…”

Improving the Differential Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care

“…26,85 In one study, 54% and 14% of patients with an initial diagnosis of asthma or COPD, respectively, had their diagnosis changed after clinical assessment (including a specific smoking history, nighttime and daytime symptoms, respiratory illness and allergy history, medication details, and family history) and spirometry. 86 ImprovIng DIagnosIs In prImary Care Despite existing tools to support diagnosis, underdiagnosis and misdiagnosis of COPD continue to be a major problem in general practice, 14,87 with differential diagnosis between asthma and COPD being a particular challenge. 15,17 Key areas for improvement include better case identification of patients and improved use of spirometry for diagnosis by trained, evaluated staff using appropriate spirometers.…”