COPD Diagnosis Often Delayed Interview with:
Erika J. Sims, PhD
Senior Researcher Research in Real Life Ltd
Cambridge, CB24 3BA

Rupert C M Jones MD
Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK

Prof David Price MD
Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK What are the main findings of the study?

Authors: The main findings are that the majority of patients with COPD identified in our study, had visited their doctor with respiratory symptoms prior to the diagnosis being made, but that the underlying cause of their symptoms – COPD – wasn’t diagnosed. Indeed, in the 5 years before being diagnosed with COPD, 85% of patients had visited their doctors with respiratory problems without the diagnosis being made. Furthermore, some patients repeatedly attended and received treatment and multiple chest X-rays before they had the diagnosis made. We also identified a large increase in the proportion of patients with comorbidity over the duration of the study, and that patients with comorbidity appear to be being diagnosed with COPD at any earlier stage. As this study includes data on 38,000 people with a diagnosis of COPD identified from two large general practice databases in the UK – Optimum Patient Care Research Database and Clinical Practice Research Datalink, we believe our findings are generalisable to UK and international primary and secondary care. Were any of the findings unexpected?

Authors: Although our findings were not unexpected, we were surprised at the scale of the problems in COPD, and that some people were having repeated course of antibiotics or steroids as well as chest X-ray, often over many years, before spirometry was performed. We showed that patients with a comorbidity appear to be diagnosed with COPD at an earlier stage suggesting that opportunities to evaluate patients for COPD while attending their GP for other reasons are being taken. What should clinicians and patients take away from your report?

Authors: We wish to highlight the need to consider COPD as a possibility and arrange spirometry in patients presenting with respiratory symptoms and infections especially if they have risk factors such as smoking. It is important to consider comorbid conditions when COPD is diagnosed and when other long term conditions such as diabetes and ischaemic heart disease are diagnosed to consider comorbid COPD. As Prof van Weel states the problem is not unique to COPD and it is not always easy for GPs to make all diagnoses at an early stage. What recommendations do you have for future research as a result of this study?

Authors: Research needs to be undertaken to evaluate how the findings of this study could be best implemented into routine primary care. It would also be interesting to examine the evolution of chronic diseases over time in a large patient cohort to identify patterns and risk factors for multiple co-morbidities including early life factors.


Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort
Rupert C M Jones MD,Prof David Price MD,Dermot Ryan MD,Erika J Sims PhD,Julie von Ziegenweidt,Laurence Mascarenhas MSc,Anne Burden MSc,David M G Halpin DPhil,Robert Winter MD,Prof Sue Hill PhD,Matt Kearney MRCGP,Kevin Holton,Anne Moger MSc,Daryl Freeman MRCGP,Alison Chisholm MSc,Prof Eric D Bateman PhD,on behalf of The Respiratory Effectiveness Group
The Lancet Respiratory Medicine – 13 February 2014
DOI: 10.1016/S2213-2600(14)70008-6

Last Updated on February 13, 2014 by Marie Benz MD FAAD