COPD misdiagnosed in 13% of patients due to NICE guidelines, study finds

An estimated 13% of COPD diagnoses in England and Wales are false because of a flawed threshold adopted in NICE guidance, research suggests.

Spirometry: COPD overdiagnosis concerns
Spirometry: COPD overdiagnosis concerns

Experts called for an overhaul of official NICE guidance on COPD after a BMJ analysis study found it has led to overdiagnosis in older men, and missed cases in young women.

Researchers called for NICE to change its guidelines and for doctors to revert back to a system which takes risk factors such as age into account.

Misdiagnosis began when a COPD diagnosis threshold, called the Global Initiative for Obstructive Lung Disease (GOLD), was introduced in 2001, Professor Martin Miller from the University of Birmingham, and Dr Mark Levy, a GP in Harrow, wrote.

Risk factors

GOLD is recommended for use by NICE as it is simpler to use, but doctors should instead use the lower limits of normal (LLN) criteria that take into account age, sex, height and ethnicity alongside spirometric data, the study says.

‘We argue that clinicians should use the LLN instead when assessing patients for COPD for ‘more accurate diagnosis,’ the authors wrote.

They believe adopting the LLN system will help improve patient care, and cut costs associated with inappropriate therapies and hospital admissions due to misdiagnosis.

Best evidence

A NICE spokeswoman told GPonline that guidelines are based on evidence available at the time, and the COPD guidance is due to be reviewed in March 2016.

‘At this point a formal check will be conducted to identify any relevant evidence that may impact the recommendations and a decision will be made as to whether any recommendations need updating. We welcome any new research that will help further develop our guidance,’ she said.

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