COPD and asthma: Diagnostic accuracy requires spirometry
J Fam Pract. 2019 March;68(2):76-81
By Christina D. Wells, MD Min J. Joo, MD, MPH Department of Family Medicine (Dr. Wells) and Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine (Dr. Joo), University of Illinois at Chicago
Up to one-third of patients receiving a clinical diagnosis of COPD or asthma have been shown to lack evidence of disease in subsequent lung-function studies.
A study of diagnostic accuracy in the primary care setting showed that among patients receiving inhaled therapies, most had not received an accurate diagnosis of chronic obstructive pulmonary disease (COPD) or asthma according to international guidelines.1,2. Other studies have shown that up to one-third of patients with a diagnosis of asthma3 or COPD4 may not actually have disease based on subsequent lung function testing.
Diagnostic error in medicine leads to numerous lost opportunities including the opportunity to: identify chronic conditions that are the true sources of patients’ symptoms, prevent morbidity and mortality, reduce unnecessary costs to patients and health systems, and deliver high-quality care.5-7. The reasons for diagnostic error in COPD and asthma are multifactorial, stemming from insufficient knowledge of clinical practice guidelines and underutilization of spirometry testing. Spirometry is recommended as part of the workup for suspected COPD and is the preferred test for diagnosing asthma. Spirometry, combined with clinical findings, can help differentiate between these diseases.
“If COPD is suspected, perform spirometry to determine the presence of fixed airflow limitation and confirm the diagnosis”.
› Perform spirometry in all patients with symptoms and risk factors suggestive of chronic obstructive pulmonary disease (COPD) or asthma. B
› Consider having a patient use a peak flow meter to support a diagnosis of asthma if spirometry is unavailable. B
› Consider the possibility of a diagnostic error if COPD or asthma is unresponsive to treatment and the initial diagnosis was made without spirometry. B
Strength of recommendation (SOR)
A. Good-quality patient-oriented evidence
B. Inconsistent or limited-quality patient-oriented evidence
C. Consensus, usual practice, opinion, disease-oriented evidence, case series
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