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Potential Misdiagnoses of Chronic Obstructive Pulmonary Disease

The need for a revaluation of chronic obstructive pulmonary disease (COPD) diagnostic practices has been highlighted by a study investigating the records of Welsh general practitioners. The researchers examined the records of 61% of the practices in Wales in their study.

This study showed that most patients who had been diagnosed with COPD had not undergone the gold standard diagnostic test for COPD: a post-bronchodilator spirometry measurement of the forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. In fact, 81% of the patients had not undergone this test. Of the 19% of patients remaining, 25% of these had an FEV1/FVC ratio ≥0.70, which suggested a potential misdiagnosis. Based on their calculations, the researchers estimated that up to 16,000 patients could have been misdiagnosed with COPD at the time of the audit, which took place from 2014–2015.

The implications of these findings are that people may be receiving unnecessary treatment, which is not only a medical concern but a great source of avoidable expenditure for healthcare services. The researchers estimated that around £1 million was being spent on the prescription of inhalers for patients who had no known asthma and a spirometry reading not indicative of COPD.

Several actions have been taken to rectify this issue, including the development of training videos for general practitioners. Additionally, approximately 1,000 nurses and healthcare assistants have taken spirometry training, with more on the waiting list, following suggestions that a multidisciplinary approach should be taken to overcome this diagnostic issue.

Although the study was based in Wales, the study leader, Dr Marie Fisk, University of Cambridge, Cambridge, UK, suggested that the situation in England was likely to be similar. She commented: “We would recommend every English practice runs searches of its Quality and Outcomes Framework register to find who has not had post-bronchodilator spirometry and who has had it but has a result with FEV1:FVC ratio ≥0.70.”