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COPD may be over diagnosed under new guidelines

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Older men are more likely to be misdiagnosed with Older men are more likely to be misdiagnosed with COPD

As many as 13% of people who are told that they have Chronic Obstructive Pulmonary Disease (COPD) could be misdiagnosed under NICE guidelines for the condition.

Writing in the BMJ, Professor Martin Miller and Dr Mark Levy suggested that the NICE guidelines for COPD skew diagnosis of the condition, with older men over diagnosed and younger women under diagnosed. This is due to the adoption of the Global Initiative for Obstructive Lung Disease (GOLD) definition of COPD, which differs from the lower limit of normal (LLN) criteria.

Concern has been raised as the GOLD guidelines suggest that COPD prevalence in those aged over 40 is 22% in England and Wales, compared with 13% using the internationally accepted LLN criteria.

The authors of the article said: 'The current NICE guidelines and the GOLD strategy documents for COPD should be modified because they over diagnose COPD in older men while missing the possibility of diagnosing heart disease; they also under diagnose COPD in young women. Continued use will lead to suboptimal outcomes and use of resources.'

The authors say that the GOLD definition of COPD misses 1 in 8 cases of airflow obstruction, which are identified under the LLN criteria. This is particularly pronounced in younger women.

The potential of misdiagnosis of COPD has raised concerns that 'patients are exposed to risks for no benefit.' Due to inappropriate medication and incorrect treatment resulting from misdiagnosis, patients diagnosed under the GOLD definition are more likely to have cardiovascular disease than those diagnosed under the LLN definition. Patients inappropriately prescribed an inhaler are also at increased risk of developing severe pneumonia.

The authors added: 'Use of LLN will also improve the accuracy of epidemiological data and save money by reducing admissions resulting from misdiagnosis and inappropriate therapy.

COPD is commonly diagnosed in its later stages and has been projected to be the third leading cause of death worldwide by 2020.

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Comments

i have recently had my spirometry training update [ARTP accredited] and i am using the LLN,this does make a difference in some patients and diagnoses have been changed/removed,however it is important to look at the trace/HSS also before you jump to remove diagnosis.
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