The new chronic lung disease guidelines either overestimate or underestimate the extent of chronic obstructive pulmonary disease (COPD) depending on the patients they're applied to, according to a new report in BMJ.
Dr. Martin Miller and colleagues from the University of Birmingham and other facilities argue that as many as 13% of people thought to have COPD under the new guidelines were misdiagnosed. The authors hold that clinicians should use internationally agreed-upon standards when assessing patients for COPD (BMJ, 1 July 2015).
The definition set by the Global Initiative for Obstructive Lung Disease (GOLD) estimates the prevalence of COPD at 22% of all those older than 40 years in England and Wales, versus 13% using internationally accepted lower limits of normal (LLN) criteria, the study authors noted. But GOLD also misses 1 in 8 cases of airflow obstruction identified by the LLN criteria, particularly among younger women.
There are concerns that young people are being underdiagnosed, especially those with early-stage disease who might benefit the most from preventive strategies, the study team wrote.
The authors believe that current National Institute for Health and Care Excellence (NICE) guidelines and the GOLD strategy documents for COPD should be modified, because they overdiagnose COPD in older men while missing the chance to diagnose heart disease; and they underdiagnose COPD in young women, the authors wrote.
They argue that clinicians should use the LLN criteria instead when assessing patients for COPD. And they call for editors of respiratory journals and their reviewers to challenge authors to examine the effect of different diagnostic methods on their results. The study team argues that clinicians should use the LLN criteria when assessing patients for COPD.
