Current COPD Criteria May Lead to Misdiagnosis

Up to 13% of patients considered to have chronic obstructive pulmonary disease (COPD) under current criteria were recently found to be misdiagnosed.

Widely used in the United States, the Global Initiative for Obstructive Lung Disease (GOLD) criteria define airways obstruction as a forced expiratory volume in 1 second (FEV1) divided by the forced vital capacity (FVC) value of <0.7, regardless of age, sex, or other demographic factors.

This fixed threshold serves as a simpler alternative to the internationally accepted lower limits of normal (LLN) FEV1/FVC standards for different populations. As such, the GOLD criteria can be easily implemented in non-specialist settings, allowing clinicians to identify more COPD cases as the prevalence and mortality rate of the disease increases.

However, an analysis published online in BMJ uncovered that the simplicity of the GOLD criteria has led to misdiagnosis, which is associated with poorer patient outcomes.

When the GOLD definition was applied in England and Wales, 22% of patients older than 40 years met the criteria for COPD, while only 13% of the same set met the LLN criteria—suggesting that the former result in significant overdiagnosis.

Overall, the analysis authors estimated that up to 13% of those diagnosed with COPD under the GOLD criteria are actually misdiagnosed.

While he did not criticize the GOLD standard, Kevin Wilson, MD, of the American Thoracic Society, explained that COPD misdiagnoses can cause “undesirable consequences,” including “missed opportunities to initiate beneficial therapies…as well as the costs, side effects, and burdens of ongoing diagnostic testing as the clinician unnecessarily seeks the cause of the symptoms.”

“The response to therapy is an important way of reassessing whether the diagnosis and treatment are correct, [and] pharmacists can play an important role” in recognizing this, Dr. Wilson told Pharmacy Times.

Breaking their results down further, the study authors found that patients who meet only the GOLD criteria have higher rates of heart disease than those who meet both GOLD and LLN standards.

“The worry is that when people are [incorrectly] diagnosed with COPD...the thinking process into diagnosis stops,” Dr. Martin told BMJ in an interview. “If someone has heart disease, and you’re treating them for COPD with drugs that could aggravate heart disease, then it compounds the problem.”