COPD patients often misdiagnosed, miss proper treatment

GLASGOW, UNITED KINGDOM — Patients with Chronic Obstructive Pulmonary Disease (COPD) are frequently misdiagnosed or remain undiagnosed, and may therefore be missing out on appropriate treatment, according to the results of a primary care study presented at the recent annual European Respiratory Society (ERS) meeting here.

COPD is a progressive respiratory disease that causes significant deterioration of lung function and chronic breathlessness that can lead to severe disability.

Limited airflow associated with COPD leads to excess air being trapped in the lungs after a person has exhaled. This condition, known as "air trapping," is a primary cause of breathlessness, which often restricts a person’s ability to perform daily activities such as walking up stairs or taking a shower.

Although COPD is the fourth leading cause of death worldwide, claiming 2.75 million lives annually, it is estimated that up to 75 percent of patients in Europe and 50 percent in the United States are undiagnosed.

Results of the study presented at the ERS congress showed that more than half of those afflicted with COPD may first be incorrectly diagnosed as suffering from asthma by their primary care physicians.

"The level of misdiagnosis and underdiagnosis seen in this study (raises concern)," said Professor David Price, chairman of primary respiratory care at the University of Aberdeen, United Kingdom, and principal investigator of the study.

"Although recent guidelines for COPD emphasize the importance of accurate diagnosis, this has been challenging in primary care. There has been varied evidence for COPD signs and symptoms, and insufficient tools to make an accurate diagnosis. As a result, patients are suffering unnecessarily because they’re not receiving appropriate treatment," Price added.

The study presented at ERS enrolled 597 patients, aged 40 and beyond, recruited from primary care practices in the UK and United States and with prior diagnoses or medications consistent with obstructive lung disease, but not previously diagnosed with COPD. The patients were given a study diagnosis based on spirometry.

Approximately 40 percent of the patients were found to have COPD. Of this number, 51.5 percent reported a prior diagnosis of asthma only, 10.6 percent reported no prior diagnosis of obstructive lung disease, and 37.9 percent reported a prior diagnosis of COPD component diseases (chronic bronchitis or emphysema).

Among the COPD sufferers originally misdiagnosed with asthma or with no prior diagnosis of obstructive lung disease, only 3.5 percent were receiving anticholinergic treatments, which together with beta-agonists are central to the symptomatic management of COPD.

"It’s time for primary care physicians to rethink their approach to COPD to ensure that patients receive an early, correct diagnosis and appropriate, effective treatment. Early intervention with smoking cessation therapy may slow disease progression, and appropriate medical therapy may slow the deterioration in a patient’s quality of life seen with COPD," Price said.

Additional study results presented at ERS showed that diagnosis of COPD in "at risk" groups (smokers and former smokers over 40 years old) could be vastly improved if patients were asked a few symptom-based diagnostic questions to assess their lung health.