One of the greatest challenges facing pulmonology professionals worldwide is under-diagnosis of COPD. In fact, many researchers estimate that the number of worldwide undiagnosed COPD cases are equivalent to diagnosed COPD cases - meaning for every one person with a COPD diagnosis there is one additional person who has COPD but is unaware they have the condition. That’s astounding when you consider that in the U.S. alone, there are over 13 million people who’ve already been diagnosed with COPD. There are a variety of reasons why the under-diagnosis dilemma exists.
First, many people who have COPD-like symptoms (e.g. recurrent bouts of persistent cough, heavy sputum, breathlessness) don’t go to see their doctor unless and until they have an exacerbation event (a term meaning a shortness of breath attack severe enough to require an emergency room visit and/or hospital stay). For example, we wrote about a UK study in April 2010 that showed 34% of people admitted for a first-time exacerbation event to UK hospitals participating in the study were previously undiagnosed for COPD. Of these people, 57% already had severe COPD before they were diagnosed. To read more about that study, click here.
Second, many people who do seek out a doctor’s evaluation tend to first visit their general practitioner. Many general practitioners address the COPD-like symptoms with a combination of antibiotics (to reduce sputum and persistent cough), bronchodilator inhalers (to temporarily open up airways and relieve acute breathlessness), and smoking cessation counseling. These are all reasonable treatment solutions to address the patient’s immediate symptoms but often times this is where the general practitioner stops. They do not often administer spirometry tests (one of the few diagnostic tests available to identify whether COPD is indicated) and do not often refer patients to pulmonologists for lung function testing.
By way of illustration, this month a Dutch team of researchers reported their findings of a 3 year study looking at undetected cases of COPD among 353 Dutch citizens who visited 73 general practitioners between 2006 and 2009 complaining of persistent cough. They found that 29% of the study participants (39% of men and 21% of women) over the age of 50 who visited their GP for persistent cough lasting 14 days or more had undetected COPD. In addition, 7% of men and women evaluated during the study were found to have undetected asthma. (Broekhuizen B, et al. Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough. British Journal of General Practice. 2010; 60:489-494)
Further, in a Canadian study we wrote about in our above mentioned April 2010 article, nearly 67% of people visiting their GP reporting one or more respiratory symptoms were unaware they had COPD and were not diagnosed by the GP during his/her evaluation.
Third, when people do receive spirometry (whether from a pulmonologist or a GP), the results of the tests are often either interpreted incorrectly or do not indicate the presence of COPD (even though other respiratory symptoms indicate COPD). In March 2010, we reported the findings of a Swedish study that showed that nearly 70% of patients in their study had initial spirometry tests that did not confirm a diagnosis of COPD. To read more about this study, click here.
This combination of factors means that tens of millions of people worldwide do not receive access to the full range of treatment options for COPD early in the development of their condition. As a result, when COPD is finally diagnosed, most “previously undiagnosed” patients are already considered moderate to severe (in the Canadian study mentioned above, 21% of the people who were finally diagnosed with COPD after their GP did not detect COPD actually were later confirmed with severe COPD).
As we’ve counseled before – if you suspect that shortness of breath, persistent cough or an increase in sputum secretion 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). You’ll also likely receive a prescription for a prescription inhaler such as Spiriva, Advair or Combivent and you may be prescribed antibiotics.
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 and CD, visit www.breathebetterforlife.com.
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