Inaccurate diagnosis of COPD: the Welsh National COPD Audit

Abstract

BackgroundThe diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction.AimTo evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD.Design and settingA primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales.MethodPatients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70).ResultsThis audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations.ConclusionPatients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.

Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study

“…As this study excluded the patients with inconsistent spirometry results from the analysis, the presence of selection bias was possible. However, this represents real-life clinical practice, as spirometry results were available only in 19-50% of COPD patients, [46][47][48] and only 11 patients (3.1%) were excluded from this study based on the spirometry result. Finally, our study result was based on a single tertiary referral centre.…”

“…49 Another data from a large Welsh COPD Primary Care Audit also reported that only 19% of COPD patients had been verified with the 'gold standard' post-bronchodilator FEV1/FVC. 48 Currently, in Thailand, COPD patients were diagnosed by physicians based on symptoms, signs, risk factors (advanced age and smoking status) and chest radiographic results that were compatible with COPD (diffuse pulmonary hyperinflation). In this study, the diagnosis of COPD was based primarily on the ICD-10 codes, as there was a study in the UK that supported the use of specific diagnostic codes to accurately identify COPD patients.…”

<p>Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit</p>

“…A recent clinical audit has evaluated the degree of inaccurate diagnosis in PCCs in Wales 12. These authors evaluated 48,105 patients and found that 13.9% of evaluated cases had compatible post-bronchodilator spirometry.…”

“…A recent review highlighted the possible clinical situations in which an inaccurate diagnosis of COPD could occur 9. Notably, the relevance of this inaccurate diagnosis has not been as exhaustively analyzed,10,11 with only few reports evaluating it, including a recent clinical audit on its prevalence in Wales 12…”

The MAGENTA model for individual prediction of in-hospital mortality in chronic obstructive pulmonary disease with acute exacerbation in resource-limited countries: A development study

“…This might threaten the validity of our model if all patients' diagnoses could not be confirmed. However, this represents the real-world clinical practice where spirometry results were only available in less than 50% of COPD patients [20,54]. Derivation of the prediction model from the cohort, which includes only patients with spirometry-confirmed AECOPD patients, might not be pragmatic.…”