Why is There Underdiagnosis of COPD?

Question: Why is There Underdiagnosis of COPD?

Answer: It appears that underdiagnosis of COPD is common in general practice, especially in those who are among high risk groups. In research presented at the 17th World Conference of Family Doctors by Jan Karounian, MD, professor of general practice at the University of Brussels in Belgium, 122 patients were studied in a semi-rural area to attempt to diagnose the presence of airway disease. 15 of these patients had been previously diagnosed. After completing a questionnaire on smoking habits, respiratory symptoms and prior history of respiratory problems, the subjects underwent spirometry testing with a handheld spirometer.

Overall, it was found that out of 89 patients with no previous diagnosis for COPD, 63% were found to have mild COPD, 33% with moderate COPD and 4% with severe COPD. That these numbers add up to 100% means that this could be a serious problem in other communities as well.

It can be reasonably certain that underdiagnosis is strongly related to a significant lack of diagnostic testing in high risk groups, such as smokers. In the above study, early detection was made with the use of office spirometry testing, which is a lung test that evaluates airflow going in and coming out of your lungs. It would be beneficial for all smokers to undergo spirometry testing on an annual basis, and doctors should urge their patients who are smokers to submit to the test. It can make a tremendous difference in the outcome of the disease.

Studies suggest that COPD is more common among smokers than previously thought. According to one study performed in Denver, Colorado, screening of smokers over 40 years of age in general practice may yield 10% 20% undiagnosed COPD cases, with a substantial proportion of these patients having moderate to severe disease.

According to the Denver study, earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.

_Source:

17th World Conference of Family Doctors: Abstract 3740. Presented October 154, 2004. Tinkelman DG, Price D, Nordyke RJ, Halbert RJ. "COPD screening efforts in primary care: what is the yield"? Prim Care Respir J. 2007 Feb;16(1):41-8.