COPD Underdiagnosed, Study Finds

Chronic obstructive pulmonary disease (COPD)is likely underdiagnosed, Czech researchers report.

A team recently reviewed existing literature to identify advances in diagnosing (COPD) and in doing so, identified some strategies that may improve accurate diagnosis.

Vladimir Koblizek of the Department of Pneumology at the University Hospital Hradec Kralove in the Czech Republic and colleagues conducted the review, a study published in Advances in Medical Education and Practice, Volume 7, on April 4, 2016.

The researchers report, “COPD remains significantly underdiagnosed, with correct diagnosis commonly missed or delayed until the pulmonary impairment is advanced.”

The most common method of diagnosis is through spirometry, and “the essential pathophysiological requirement for COPD diagnosis is the presence of a post-BD expiratory airflow limitation, which is defined, according to the current European Respiratory Society (ERS) statement, as a decrease in the forced expiratory volume in 1 second (FEV1)/vital capacity (VC) ratio below the lower limit of normal (LLN) values,” according to the researchers.

Exacerbation history is an important part of diagnosis as well, and so is the taking of universal COPD symptoms by using a tool such as the COPD Assessment Test (CAT) or the modified Medical Research Council (mMRC) dyspnea scale. The researchers say that using three different parameters, patients can be classified into one of the four categories of the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

Regarding the GOLD categories, the researchers say, “Physicians worldwide feel that the clinical variety of this disease greatly exceeds the two-dimensional diagram of dividing the patients into four A-D categories.” They go on to say that GOLD is designed only to be the minimal strategy for diagnosing and treating COPD, rather than a guideline.

COPD is often undiagnosed because may be considered a geriatric condition due to the fact the prevalence of the disease increases dramatically with age. Additionally, symptoms may overlap with comorbidities. The researchers say, “Educated physicians are able to distinctly improve appropriate diagnosis of COPD,” and that “adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD.”

The researchers conclude that “Because guidelines appear to influence clinical decision-making, efforts to propagate them more broadly are needed.”

They specifically suggest focusing on algorithms for use in primary care settings, strengthening spirometry skills, and discussing approaches to treatment strategy.