A greater focus is urgently needed on improving diagnosis of COPD, say researchers, who have found that a quarter of patients on GP registers may have been misdiagnosed.
The study of data from the Welsh National COPD Audit, published in the British Journal of General Practice, has shown that poor documentation of spirometry and its interpretation are a challenge.
The audit, conducted in 2014-15 on 48,105 patients from 63% of Welsh practices, found that only 19% of patients were post-bronchodilator FEV1/FVC Read-coded. Among these patients 25% had incompatible spirometry suggesting they may have been misdiagnosed.
If these audit results were extrapolated to the estimated COPD prevalence in the population of Wales, this would imply around 16,000 misdiagnosed cases.
The patients who had been misdiagnosed with COPD were symptomatic suggesting they had an underlying medical problem.
The researchers comment that the absence of a Read-coded FEV1/FVC ratio does not imply that such a test has never been performed but does promote a view that its importance in ensuring an accurate diagnosis is not at the forefront of clinicians’ management strategies.
“This study suggests that a concerted effort to determine an accurate diagnosis in these patients is urgently needed, to reduce both potential harm to these patients and the financial cost from unnecessary treatments or interventions,” they conclude.
Dr Katherine Hickman, PCRS Executive Vice Chair elect and newly appointed Primary Care Lead of the National Asthma and COPD Audit (NACAP), said: “We have had two audits in Wales so far which have shown quite striking poor standards of care of patients with serious COPD.
“We are fairly sure there is the same picture of poor COPD care in England and Scotland and the Royal College of Physicians and the Healthcare Quality Improvement Partnership is working hard to establish a national COPD audits in these countries. This will give individual practices and CCGs the data they need, wrapped around the audit, to make the necessary quality improvements in their areas.”
This study highlights the need to:
- Check that there is an accurate accredited spirometry trace with a FEV1/FVC ratio consistent with a diagnosis of COPD, in a patient’s notes when they come for a review
- Make sure the trace has been coded correctly with the Read codes available on the Royal College of Physicians website
- If a trace isn’t in the notes the patient should be referred for a spirometry test.