LAUSR

Background: Previous studies have suggested that COPD is commonly misdiagnosed in primary care, however, the prevalence of diagnostic inaccuracies is not known. Aims: To evaluate the diagnostic accuracy of COPD in the Knowsley primary care register. Methods: In 2011, the consultant-led Knowsley Community Respiratory Service was established to oversee the care of 5,281 COPD patients that had a diagnosis of COPD based on the primary care register. All patients were invited by the service for clinical review including post-bronchodilator spirometry test. Results: 3,554 patients attended for review at least once between 2012 and 2015, of whom 2,813 patients had evidence of post-bronchodilator obstruction. 741 (20.8%) patients were found to have spirometry results inconsistent with a diagnosis of COPD; 723 had normal (97.6%) and 18 (2.4%) had restrictive results. Females were more likely to have inaccurate diagnosis of COPD (n= 481). 324 were current smokers; 251 were ex-smokers and 166 had never smoked cigarettes. Following specialist review, 445 of the 741 patients were diagnosed to have asthma, 62 had interstitial lung disease and in 234 patients, no respiratory conditions were identified. Conclusions: For patients that are referred to specialist care from primary care, the diagnosis of COPD should always be reviewed. The diagnosis of COPD should be made by a combination of clinical symptoms, risk factors and spirometry. The failure to correlate these factors account for the high diagnostic inaccuracies in primary care and emphasises the importance of high quality education to healthcare professional involving in COPD care. Primary care register also requires periodic update to reflect accurate diagnosis.