GPs 'should retest all COPD and asthma patients'
By Nigel Praities
GPs may be asked to call in all their patients over 35 years with COPD or asthma to check their diagnosis, after a major respiratory organisation submitted evidence to the Government of widespread misdiagnosis.
A British Lung Foundation survey of 776 GPs showed 80% found differentiating between asthma and COPD ‘quite' or ‘very' challenging.
More than a quarter did not have the training to interpret the results of spirometry testing themselves and 10% did not have the staff to do this either.
The BLF is playing a key role in putting together the Government's forthcoming National Service Framework – now renamed the Clinical Strategy – for COPD.
Dr Keith Prowse, chair of the British Lung Foundation, said diagnosis of COPD was ‘a major source of confusion', and that the BLF was pushing for more accurate diagnosis to be a central feature of the strategy.
‘It is not easy to tell the difference between asthma and COPD, but it is important to ensure patients get the right treatment,' he said.
The strategy is due for publication in the spring and as Pulse has previously revealed, is likely to recommend lung health checks for patients at risk of COPD.
Dr Prowse called for retesting of all patients over 35 with asthma or COPD, saying many calls on their helpline were from distressed patients whose GP diagnosis had changed after visiting a specialist.
‘[Re-testing] would mean people get the right clear diagnosis and secondly they get the right treatment from now on,' he said.
But Dr John Haughney, a GP in East Kilbride and member of the General Practice Airways Group, criticised the proposals as unpractical and unnecessary.
‘For many of these patients it would be a post-treatment reading and are we really going to ask them to stop taking their medication so that we can get an accurate diagnosis?'
‘Sometimes we get too concerned over the 5 or 10% who have a difficult diagnosis, but that means GPs are getting it right 90% of the time,' he said.
The BLF also surveyed 100 respiratory specialist units and found 65% of specialist doctors said they also found it hard to distinguish between asthma and COPD.
They had very little faith in GPs either, with 31% saying QOF had failed to improve diagnosis and 23% saying it had not improved the quality of care.Diagnosing COPD in primary care
Apr 04 – COPD and asthma indicators included in launch of QOF
Jul 05 – Government-funded study suggests nearly a third of patients on COPD registers do not actually have the disease
Nov 07 - British Lung Foundation estimates 2.8 million people have undiagnosed COPD and calls for screening of over-35s
Dec 07 – Figures show the prevalence of diagnosed COPD has jumped by almost 15% in two years since introduction of the QOF
Jan 08 - Prime Minister Gordon Brown calls for earlier intervention in long-term conditions and Pulse reveals lung health checks will be part of the Government's Clinical Strategy for COPD
Spring 09 – Projected release of Government Clinical Strategy for COPD