Two recent published studies highlight the challenges faced by physicians to diagnose COPD among those who suffer from chronic shortness of breath. From past research studies and practical experience, pulmonology professionals believe there are as many as 12 million people in the U.S. who have COPD but have not been diagnosed – a group sometimes referred to among respiratory health professionals as the “unaccounted”.
For a frame of reference, there are approximately 12 million U.S. adults who have been already diagnosed with COPD – meaning that roughly 50% of all U.S. adults with COPD have no idea they have this degenerative, largely irreversible condition. Due to this substantial under-diagnosis, the “unaccounted” are not gaining access to the full range of treatment options that could help slow down and possibly halt the progression of lung disease.
Why are so many people that are suffering from chronic shortness of breath undiagnosed as COPD patients? In our view, the three most common reasons, in order of prevalence, seem to be as follows:
(1) Many people don’t visit their doctors to be evaluated and discover they have COPD only after an acute exacerbation (doctor-speak for a shortness of breath attack serious enough to land you in a hospital).
(2) Some people who do visit a doctor about their shortness of breath are evaluated only by their primary care physician, not a pulmonologist. Primary care physicians sometimes incorrectly diagnose the patient and/or don’t refer the patient to a pulmonologist to conduct respiratory function tests even if COPD risk factors are present.
(3) Some people who do undergo respiratory function tests (most notably spirometry) receive a false-negative diagnosis – meaning the tests do not confirm COPD even though later testing confirms a COPD diagnosis. This happens most often because the spirometry test was either poorly administered or interpreted.
Reason (1) is reinforced by a recent study published in Chronic Respiratory Disease. In this study, a group of U.K. researchers set out to examine the case records of people admitted to a London area hospital over a 1-year period. They wanted to determine the percentage of COPD patients who received their initial COPD diagnosis as a result of a first-time hospitalization related to an acute exacerbation event.
The research team discovered that 34% of the 41 patients admitted for the first time related to an acute exacerbation were previously undiagnosed with COPD. These patients received respiratory function tests during their hospitalization that confirmed a COPD diagnosis. More troubling, 57% of those who were previously undiagnosed presented severe COPD symptoms – meaning that the majority of the undiagnosed waited so long to seek help for their chronic shortness of breath that they were deep into lung disease before gaining access to treatment. (Bastin AJ, et al. High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation. Chron Respir Dis. 2010: March 18. [Epub ahead of print])
Reason (2) is highlighted by the results of another recently published study, this one in the April 2010 Canadian Medical Association Journal. In this study, Canadian researchers surveyed a group of 1,003 COPD patients who were at least 40 years of age and had smoked for at least 20 years (the mean age of the group was approximately 60) and who had visited their primary care physician for any reason between April 2006 and February 2007. In particular, the researchers wanted to know whether COPD diagnosis was determined by the primary care physicians.
The study found that 21% of the surveyed patients had either Stage II (moderate) or Stage III/IV (severe to very severe) COPD but were not diagnosed by the primary care physician they visited. The research team further noted, “Although more than three-quarters of the patients with COPD reported at least one respiratory symptom, two-thirds were unaware of their diagnosis. These findings suggest that adults who attend a primary care practice with known risk factors for COPD are important targets for screening and early intervention.” (Hill K, et al. Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. CMAJ 2010. DOI: 10.1503/cmaj.091784).
Reason (3) is supported by a research study we wrote about last month. You can access that article by clicking here.
The bottom line for you – if you suspect that your shortness of breath is increasingly affecting your ability to participate in everyday activities you owe it to yourself to see your doctor ASAP. Yes, you’ll probably have to undergo some tests and you will likely hear an earful about stopping smoking, exercising more and/or changing your dietary habits (all excellent recommendations for making an immediate impact on your shortness of breath). When you visit your doctor, ask for a referral to a local pulmonologist and in turn ask the pulmonologist to order a spirometry test. You are far more apt to get a correct diagnosis by seeking an evaluation from a qualified pulmonologist trained to administer and interpret spirometry results than through any other means. In the end , you have a far better chance of limiting the ravaging effects of severe lung disease by seeking treatment sooner rather than later – even if some of the prescribed solutions mean altering your long practiced habits.
If you are unfamiliar with the treatment options available for COPD, we have detailed the full range of treatment options in our Breathe Better for Life guide and companion CD-ROM. We developed the guide and CD to provide people who suffer from chronic shortness of breath with self-management strategies for reducing shortness of breath, improving physical conditioning, and improving overall quality of life (whether you have COPD already or you are a current/former smoker and you'd simply like to breathe & feel better). However, our guide and CD describe the full range of COPD treatment options including pictorial demonstrations. To purchase the guide & CD, visit www.breathebetterforlife.com.
Alternatively, for a brief overview of COPD treatment options you can visit the COPD treatment options page on the American Lung Association web site by clicking here.
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