TOO HOT…….TOO COLD
Most of us will remember the story of Goldilocks and the three bears and the soup which was either too hot or too cold and one that was just right. This seems to be where we are with the diagnosis of COPD. I have written many times (you may be tired of reading it) that the diagnosis should be made with pulmonary function testing, and that many people have unrecognized COPD (too cold). Symptoms of COPD, like shortness of breath and cough, are non-specific and often misinterpreted as related to normal aging or attributed to other conditions such as asthma or cardiovascular disease.
The other side of this coin is also true, i.e. over diagnosis is common when based just on symptoms alone (too hot). When patients are prescribed medications for this, or any other disease process that they do not have, it results in unnecessary costs with the potential for serious side effects.
In a recent large international study, 919 patients reported a diagnosis of COPD but of that group 569 (61.9%) did not have the basic pulmonary function findings consistent with this diagnosis (once again, too hot). Over diagnosis was more prevalent in high income countries, and the same applies to overtreatment. Many of the over diagnosed patients did have a breathing study, but it was misinterpreted. To put a finer point on this discussion, under diagnosis can be seen in over 81% of patients surveyed.
The answer may be proper testing reviewed by someone who knows what’s just right.