A retrospective, 20-year study led by researchers at Plymouth University Peninsula Schools of Medicine and Dentistry shows that in up to 85 per cent of patients with chronic obstructive pulmonary disease (COPD) the underlying disease was being overlooked. Missed opportunities occur commonly in both primary and secondary care. The paper demonstrates the pointers to help GP to come to a earlier diagnosis. The findings are published in The Lancet Respiratory Medicine.
The study encompassed almost 39,000 patients and showed that, in the UK, opportunities to diagnose COPD are frequently missed in both primary and secondary care settings.
The study was led by Dr. Rupert Jones, Clinical Research Fellow at Plymouth University Peninsula Schools of Medicine and Dentistry and a working GP in Plymouth.
He said: "This was a project which came from my work with the Department of Health, on the National COPD outcomes strategy -- a stream of work which I have been involved in since 2005. We became acutely aware that many people were being diagnosed with COPD, a progressive and disabling lung disease, at a late stage when the damage done was severe and irreversible. Thus we wanted to examine the opportunities arising in primary care in order to diagnose COPD at an earlier stage and improve health outcomes, with potential to extend life expectancy and quality of life for patients."
The research team used data from the General Practice and Optimum Patient Care Research databases. They assessed whether a diagnosis of COPD could have been made in an earlier visit to a doctor, whether in a primary or secondary care setting. From the databases 38,849 patients aged 40 or older and who had received a diagnosis for COPD were identified. The diagnoses had been made between 1990 and 2009 and for each data was available at least two years before and one year after diagnosis.
Results showed that in the five years before diagnosis, 85 per cent of patients had visited their GP at least once with lower respiratory symptoms without the diagnosis of COPD being made. Opportunities for diagnosis were missed in 58 per cent of patients in the six to 10 years before diagnosis, and in 42 per cent in the 11 to 15 years before diagnosis.
The study identified that, over the 20 year study period, there was a significant increase in the number of chest X-rays in the two years prior to diagnosis, but that only a third of those patients were given spirometry testing (a breathing test used to diagnose lung conditions and which measures how well the lungs work.
It is estimated that around 2.2 million people in the UK remain undiagnosed for COPD. The UK Department of Health estimates that earlier diagnosis and treatment could save the NHS more than £1 billion over 10 years.
Said Dr. Jones: "The numbers are large, both in terms of people affected and the cost to already stretched NHS provision of care. We believe that the results of our study provide clear support to the argument for improved identification and diagnosis of COPD in general practice, with greater awareness so that early opportunities to diagnose -- such as presentation with lower respiratory tract symptoms or related conditions -- are seized and acted upon."
- Rupert C M Jones, David Price, Dermot Ryan, Erika J Sims, Julie von Ziegenweidt, Laurence Mascarenhas, Anne Burden, David M G Halpin, Robert Winter, Sue Hill, Matt Kearney, Kevin Holton, Anne Moger, Daryl Freeman, Alison Chisholm, Eric D Bateman. Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort. The Lancet Respiratory Medicine, 2014; DOI: 10.1016/S2213-2600(14)70008-6
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