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GPs urged to find patients left undiagnosed with COPD

GPs will be tasked with going through their records to find anyone aged over 35 who may have COPD, under Government guidance issued to CCG leaders.

The guidance is designed to identify 2m patients who remain undiagnosed with COPD, and urges GPs to go through their records to find anyone who has presented with symptoms such as exertional breathlessness or chronic cough.

It also reveals the DH is trialling use of ‘microspirometry' and peak-flow testing in GP practices to see if they should be rolled out to better identify patients with the disease, although GPs have warned spirometry would still be needed to confirm diagnosis.

The document is designed to support CCG targets under last year's Outcomes Strategy for the COPD and Asthma, which the DH claimed would help save 7,800 lives a year.

Several other DH documents have recommended COPD case finding in primary care, but this is the first initiative to be rolled out to CCGs, and COPD targets are likely to be backed with financial incentives once details have been agreed of the planned quality premium.

The list of targets for CCGs includes reducing premature mortality and improving quality of life for COPD patients through a ‘proactive approach' to early identification of disease.

The guidance says: ‘NICE recommends COPD should be considered in people over 35 who have a risk factor (generally smoking) and present with exertional breathlessness, chronic cough, regular sputum production, frequent winter ‘bronchitis' or wheeze.

‘Targeted case finding can be done through auditing GP registers to identify people whose treatment history and symptoms suggest COPD may have been missed or that COPD has been incorrectly diagnosed.'

The guidance said any initiative to address COPD underdiagnosis should not increase COPD misdiagnoses, and the DH is trialling case-finding tools in practices in York and Hull, with a view to a wider rollout.

Health minister Simon Burns said: ‘We're encouraging GPs to look for patients who are at risk and make sure they're properly tested and diagnosed.'

‘Better quality care is cheaper care – with proper diagnosis and treatment we can make a big difference in quality of life for people with COPD and asthma, and save the NHS money.'

Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, and member of the education committee of the Primary Care Respiratory Society, said it was ‘refreshing' the Government was testing new techniques before rolling them out: ‘There is good evidence that hand-held spirometers are a useful initial screening tool but are no substitute for high quality-assured  diagnostic spirometry to make the actual diagnosis.'

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