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Routine GP audit of asthma care can halve symptoms

NICE guidance claiming reversibility testing is not needed to distinguish asthma and COPD is incorrect and is causing widespread misdiagnosis, researchers conclude.

One in six patients diagnosed with COPD would be reclassified as having asthma if they had a reversibility test, the research found.

A second study found GPs were underusing spirometers and lacked confidence to interpret results.

NICE guidance published in February claimed revers-ibility testing could be 'unhelpful' and even 'misleading' in diagnosing COPD.

But in the new audit, researchers tested 173 patients for reversibility who had FEV1/FVC below 70 per cent (the NICE criteria for COPD) and found 16 per cent actually had asthma.

The study also reopened the controversy over whether reversibility is required to score quality points.

While the contract suggests it is necessary to test for reversibility, the Read codes for calculating pay are triggered by any form of spirometry.

Study author Professor David Price, professor of primary care at the University of Aberdeen, said: 'You need to be very careful if you're going to follow NICE guidance as 16 per cent is quite a large amount of misdiagnosis.'

Professor Price said NICE had looked at evidence for moderate to severe COPD, which did not reflect the make-up of patients in primary care. He added: 'The danger is patients start treatment, don't get reviewed and continue on inappropriate treatment.'

Dr David Bellamy, a member of the NICE guideline development group for COPD, denied NICE had said reversibility testing was never necessary but said some patients had such obvious COPD they would not need testing.

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