1 in 10 people identified as having Chronic Obstructive Pulmonary Disease (COPD) have no definitive diagnosis, yet the majority of them are being prescribed inhaled drugs for a condition they are unlikely to have - according to new research presented at the British Thoracic Society’s Winter Meeting today (Wednesday 6th December 2017).
The study of 16,479 COPD patients across Hampshire has shown that 10% had no evidence of airflow obstruction to support their diagnosis, and yet 79% were receiving inhaler treatments.
Chronic Obstructive Pulmonary Disease (COPD) is the name for a group of lung diseases that narrow the airways causing breathing difficulties. COPD inflicts a huge toll on patients, their carers, and on the NHS. In total, 1.2 million people in the UK have been diagnosed with COPD. There are 30,000 deaths from the disease in the UK each year.
The study was prompted by the National COPD Audit Programme in 2016 which had revealed that in a quarter of cases nationwide, spirometry (a key breathing test) values were not consistent with the given diagnosis of Chronic Obstructive Pulmonary Disease (COPD).
Dr Lynn Josephs, Clinical Research Consultant Fellow at The University of Southampton scrutinised anonymised data, to review the characteristics, medication and other health conditions of patients diagnosed with COPD - comparing those with, and without, evidence of airflow obstruction.
The next stage of data analysis was to question whether there was an asthma diagnosis which might explain the study findings, since similar inhalers are prescribed for both conditions.
Yet, even after excluding all patients with a diagnosis of asthma, which left 12,235 patients with COPD, 1,182 still had no evidence of airflow obstruction from a spirometry test, and yet 50% of these were receiving long-acting bronchodilator inhalers and 50% were receiving inhaled corticosteroids; both of which are expensive treatments only recommended for confirmed, moderate or severe COPD.
Only 28% of patients were on no respiratory treatment.
Dr Josephs, who led the research, says:
“It is well known that there is under-diagnosis of COPD and this is a major problem, yet this study highlights an additional issue that there are also a considerable number of cases of over-diagnosis. Without confirmatory spirometry testing, which is fundamental to diagnosis, a high number of patients were still diagnosed with, and given medication for, COPD.
Since there is no evidence of COPD, nor of asthma in some cases, there is concern that the prescriptions given may not always be appropriate – either being ineffective or potentially harmful to those patients.
We would advocate a reassessment of such patients, as there may be other causes for their symptoms which have been missed, and alternative treatment options.
Both under-diagnosis and over-diagnosis of COPD highlight the need for adequate access to quality assured spirometry in primary care.”
For more information prior to the British Thoracic Society Winter Meeting (that is, before Wednesday 6thDecember 2017), please contact:
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Ed Gyde t: 020 7831 8778 or 07809 574801
During the British Thoracic Society meeting (from Wednesday 6th to Friday 8th December 2017):
Please contact the BTS news media office on t: 020 7798 4801/ 020 7798 4541 or the mobile numbers above.
Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has over 3,400 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest. For more information, go to www.brit-thoracic.org.uk
The British Thoracic Society Winter Meeting takes place from Wednesday 6th to Friday 8th December 2017 at the Queen Elizabeth II Conference Centre in Westminster, London.