It still amazes me that, although chronic obstructive pulmonary disease (COPD) affects 3.7 million people in the UK, and is expected to become the world's biggest killer by 2020, barely anyone I know (outside of the office) has heard of it.
Emphysema is better understood, but not necessarily by younger people, if my recent straw poll of family and friends is anything to go by; those who are smokers did not particularly associate COPD with their habit, despite the fact that smoking is the primary cause of the disease
It seems that a public awareness campaign is much needed, along with systematic spirometry testing, according to the British Lung Foundation (BLF). In a recent editorial in Independent Nurse, the Foundation's chief executive Dame Helena Shovelton stressed that spirometry testing should be included in proposed health MOTs.
This would need to involve significantly improved training and confidence in spirometry testing for primary care given that, this week, the BLF revealed that most GPs have difficulty telling COPD from asthma. A poll of 776 GPs showed that 80 per cent of doctors found differentiating between asthma and COPD ‘quite' or ‘very challenging'.
The study also identified that one in 10 GPs did not have staff who had been trained to carry out or interpret the necessary tests. The BLF is consequently calling for everyone over 35 with asthma or COPD to be retested, since the long-term aims of asthma and COPD treatment are different and it is vital that people with either disease have an accurate diagnosis.
Preventing misdiagnosis may involve changes to the Quality Framework (the BLF says the GMS contract must reward clear diagnosis of asthma and COPD), plus an overhaul of NICE spirometry definitions: a recent story in Independent Nurse reported Dutch researchers' findings that, where a fixed cut-off definition of airway obstruction was used (as is recommended by NICE and other COPD guidelines) this led to misdiagnosis in around a quarter of patients
Meanwhile, The National COPD Audit 2008 (carried out by National COPD Resources and Outcomes Project and backed by the Royal College of Physicians (RCP), the British Thoracic Society and the BLF) found that treatment of COPD had improved since 2005 but is still patchy across the country.
Staffing in many COPD assessment units remains below the level recommended by the RCP; insufficient information is given to COPD patients; and the provision of palliative care services is highly variable.
Clearly, a great deal needs to be done to reduce inconsistencies in COPD services, to boost public and physician awareness of the disease, and to improve skills in testing and diagnosis.
The good news is that the government in England is due to publish a national strategy for COPD next year, which should aim to address at least some of these issues.
The bad news for busy primary care health professionals is that it looks as if a great deal more work is about to be coming their way!