COPD Guidelines Over-Diagnose Older Men, Under-Diagnose Younger Women

According to a recent study published in The BMJ, new guidelines to diagnose chronic lung disease (chronic obstructive pulmonary disease or COPD) should be modified since they under-diagnose COPD in young women and over-diagnose COPD in older men.

Martin Miller and Dr. Mark Levy, authors of the article, noted that up to 13 percent of people were diagnosed COPD according to the new diagnostic criteria were found to be misdiagnosed.

They explained that clinicians should utilize the internationally agreed standards when they are assessing patients for COPD. By doing so, it would help improve patient care and cut down wasteful spending in healthcare through a more accurate diagnosis by reducing admissions resulting from inappropriate therapy and misdiagnosis.

COPD related prevalence and mortality are increasing worldwide. Smoking is the cause about 75 percent of the cases, which represents an annual cost of £800m in the United Kingdom (equaling €1bn; $1.24bn).

In the other hand, while COPD is being under-diagnosed among those in the early stages of the condition, the current diagnostic criteria are leading to over-diagnosis in other groups.

Estimates from the GOLD criteria indicate COPD prevalence at 22 percent in those 40 years and older in England and 13 percent in Wales according to the LLN criteria. Further, 1 in 8 cases of airflow obstruction are missed from those identified by the LLN, especially among younger women.

GOLD was adopted by the UK National Institute for Health and Care Excellence (NICE) and is commonly used in Europe, United States and Australasia.

About 13 percent of those thought to have COPD from the GOLD criteria were misdiagnosed. This might lead to poorer results “because of adverse effects of inappropriate medication or incorrect treatment.”

Using inhaler treatment to address COPD substantially increases the likelihood of advancing severe pneumonia. “Patients with misdiagnosed COPD are exposed to these risks for no benefit,” they explained. “[NICE guidelines] should be modified because they over-diagnose COPD in older men while missing the possibility of diagnosing heart disease; they also under-diagnose COPD in young women.”

The researchers conclude by suggesting that LLN should be used instead to assess individuals for COPD.