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By Daniel Cressey

UK guidelines on COPD are far less effective at detecting the disease than other major international standards, a study reveals.

The researchers urged GPs to use a revised version of the European Respiratory Society guidelines instead after finding they detected twice the number of cases as the British Thoracic Society guidance (see box).

Study leader Professor David Wilson, associate professor in the department of medicine, University of Adelaide, said: 'Given the extent of the COPD problem, many cases where the GP's intervention could make a difference will be missed.

'The variation in diagnostic rates using international guidelines is a problem in that some will produce false negative and/ or false positive cases of COPD.'

The study, published in the latest issue of Chest, assessed COPD in a group of 2,501 Australians, and found prevalence was 3.5 per cent with BTS guidelines, 5.4 per cent with those from the American Thoracic Society, 5.0 per cent with ERS and 5.4 per cent with GOLD guidelines.

But an adapted version of ERS using 'more inclusive' one standard deviation reference values gave a prevalence of 6.9 per cent.

Professor Wilson said: 'We would argue that the increasing COPD problem, particularly in women, requires age and gender specific criteria which ERS criteria are. Fixed criteria such as BTS also will underdiagnose in younger age groups and overdiagnose in older age groups.'

Professor Andrew Peacock, chair of the British Thoracic Society's communications committee, said: 'This is quite an important point they're making. We really do need international agreement on what constitutes COPD and what doesn't. It would be a good idea if international bodies could get together and agree.'

Dr Chris Woodforde, a GP fellow in respiratory health at Halton PCT, Cheshire, warned that too many COPD patients were being caught too late: 'A lot of people are presenting as moderate or severe COPD when the damage has already been done.

'We've advised practices to record FEV1 percentage in the notes so if the guidelines do change you don't have to change your parameters.'

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