A retrospective study of almost 39,000 patients shows that opportunities to diagnose chronic obstructive pulmonary disease (COPD) at an earlier stage are frequently being missed in both primary and secondary care in the UK. The findings, published in The Lancet Respiratory Medicine, reveal missed opportunities to diagnose COPD occurred in up to 85 percent of people.
"The substantial numbers of patients misdiagnosed and under diagnosed in this study is a cause for concern. It is important that COPD is diagnosed as early as possible so effective treatment can be used to try to reduce lung damage, improve quality of life, and even life expectancy", explains author Dr Rupert Jones from Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK.
"The first signs of lung disease should prompt appropriate investigations such as pulmonary function tests (spirometry)
. However, both general practitioners (GPs) and patients are failing to recognize the significance of symptoms."
The UK Department of Health estimates that around 2.2 million people in the UK are undiagnosed and state that earlier diagnosis and treatment could save the National Health Service more than £1 billion over 10 years.
Using data from the General Practice and Optimum Patient Care Research databases, the researchers assessed whether a COPD diagnosis might have been made in an earlier primary or secondary care visit. They identified 38 859 patients aged 40 years or older who had received a COPD diagnosis between 1990and 2009 and for whom data was available for at least two years before and one year after diagnosis.
Results showed that in the 5 years before diagnosis, 85% of patients had visited their GP or a secondary care clinic at least once with lower respiratory symptoms. These consultations represent missed opportunities to further investigate patients for a possible diagnosis of COPD. Opportunities for diagnosis were missed in 58% of patients in the 6–10 years before diagnosis and 42% in the 11–15 years before diagnosis.
Over the 20 year study, a significant increase in the number of chest x-rays in the 2 years before diagnosis was noted, but only a third of these patients were also given spirometry testing
They researchers say, "Although we have seen small improvements in earlier diagnosis over the past 20 years, many patients are still being diagnosed with severe or very severe airway... Read more..