Patients with chronic obstructive pulmonary disease (COPD) are often misdiagnosed or remain undiagnosed, and thus may be missing out on much-needed treatment, warns a primary care study unveiled at a medical conference in Glasgow, Scotland recently.1
"The level of misdiagnosis and under-diagnosis seen in this study is very concerning," said David Price, MD, chairman of Primary Care, Respiratory, at the University of Aberdeen in Scotland, and the study's chief investigator. "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."
What's Known About the Disease
COPD refers to a group of diseases that cause airflow blockage and breathing problems. These include emphysema, chronic bronchitis, and in some cases, asthma. COPD is considered the fourth leading cause of death in the U.S. Tobacco use is a key factor in the development and progression of COPD, but asthma, exposure to air pollution in the workplace and home, genetic factors, and respiratory infections also play key roles.
There is no cure for the disease. Drugs prescribed can only help people manage their symptoms. Avoiding cigarette smoking is one prophylactic approach, as well as removing air pollutants from one's surroundings. Symptoms like coughing or wheezing can be treated with medicine. Respiratory infections are commonly treated with antibiotics, if appropriate, and patients with low blood oxygen levels are often given supplemental oxygen.2
It's estimated that up to half of all patients with COPD may be undiagnosed.3 Results of the Scottish study showed that more than half of those affected with COPD may first be incorrectly misdiagnosed with asthma by their primary care physician.
Misdiagnoses Uncovered
For the research, Price and his colleagues enrolled nearly 600 patients recruited from primary care practices in the U.K. and U.S. over age 40 with a prior diagnosis or medications consistent with obstructive lung disease, but not previously diagnosed with COPD. Patients were given a study diagnosis based on spirometry, a measurement of air volume that is either exhaled or inhaled.
About 40 percent of the patients in the study were diagnosed with COPD. Of those, more than half reported a prior diagnosis of asthma only, about 10 percent reported no prior diagnosis, and about 38 percent reported that they'd been diagnosed with one of the diseases that make up COPD: either chronic bronchitis or emphysema.
Among those COPD patients originally misdiagnosed with asthma or with no prior diagnosis, only a small percentage was receiving anticholinergic treatments, which together with beta-agonists are typically prescribed to manage symptoms of the disease. Anticholinergic medications include tiotropium bromide, a bronchodilator recently approved by the FDA.4 Beta-agonists are bronchodilators that relax the muscle of the bronchial tubes.5
'Rethink Approaches', Experts Urge
"It's time for primary care professionals to re-think their approach to COPD to ensure patients receive an early, correct diagnosis and appropriate, effective treatment," Price said. "Early intervention with smoking cessation therapy may slow disease progression, and appropriate medical therapy may slow the deterioration in patient quality of life seen with COPD."
Price and his team also found that diagnosis of 'high-risk' patients with COPD, which includes those over age 40, regardless of their smoking history, could be vastly improved if doctors asked a few symptom-based diagnostic questions to evaluate the health of their patients' lungs. If these questions were used for testing purposes in a primary care setting, testing 1000 people at high risk would lead to nearly 300 spirometry exams and 100 new diagnoses of COPD, the study team concluded.
"This simple questionnaire promises to be a cost-effective means of improving diagnosis rates, and thus appropriate management of one of the most common, debilitating and costly conditions seen in primary care," Price said.
1. Price D, Tinkelman DG, Nordyke RJ et al. Underdiagnosis of COPD and impact of a new diagnostic questionnaire. 14th Annual Congress of the European Respiratory Society. 2004 Sep 4-8. Glasgow, Scotland.
2. National Center for Environmental Health. Centers for Disease Control and Prevention (CDC). Facts About Chronic Obstructive Pulmonary Disease.
3. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance—United States, 1971-2000. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. 2002 Aug 2;51(SS06):1-16.
4. ZuWallack ARR, ZuWallack RL. Tiotropium bromide, a new, once-daily inhaled anticholinergic bronchodilator for chronic obstructive pulmonary disease. Expert Opin Pharmacother 2004 Ag;5(8):1827-35.
5. American Academy of Allergy, Asthma & Immunology. Tips to Remember: Asthma & Allergy Medications.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
