Diagnosing COPD in general practice
COPD prevalence is likely to be underestimated in the UK. Anne Rodman explores the current evidence base for diagnosing COPD
Chronic obstructive pulmonary disease (COPD) is an umbrella term for several different pathological processes in the lungs of susceptible individuals. COPD should be considered in any patient who has symptoms and a history of exposure to risk factors for the disease. The cornerstone of COPD diagnosis is to identify risk factors for this preventable condition, recognise and investigate any symptoms that are not commonly found in COPD, and confirm that obstruction is present with correctly performed and interpreted spirometry. This article explores the current evidence base for diagnosing COPD, how to differentiate it from asthma and other conditions with similar symptoms, and the rationale for specialist referral.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD 2021; p4) defines chronic obstructive pulmonary disease (COPD) as ‘a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases’.
COPD is an umbrella term for several different pathological processes in the lungs of susceptible individuals. These cause various persistent symptoms that usually lead to increasing disability and premature mortality for those affected. Because of the heterogeneity of COPD and its association with several important comorbidities, misdiagnosis and underdiagnosis may commonly occur (Jørgensen and Brunak, 2021). The prevalence of COPD varies internationally depending on the methods used to define it, for example self-report by study participants or rigorous investigation using standardised tests. In the UK, it is known to affect around 4.5% of the population over the age of 40, and 2% of the overall population with a prevalence slightly higher in males than females (British Lung Foundation, 2021). It is thought, however, that the true prevalence may be double the actual number diagnosed.
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