Abstract
BackgroundAsthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment.AimTo quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.Design and settingPatients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires.MethodThe prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information.ResultsIn total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, n = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD.ConclusionA concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.
Highlights
Worldwide, 358 million people are estimated to be affected by asthma[1] and 174 million by chronic obstructive pulmonary disease (COPD).[2]
Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, COPD was only likely in 14.8% (95% confidence interval [confidence intervals (CIs)] = 11.3 to 19.0) of patients with validated asthma
When considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% of patients with validated COPD
Summary
358 million people are estimated to be affected by asthma[1] and 174 million by chronic obstructive pulmonary disease (COPD).[2] Both diseases can vary greatly in their presentation, and imprecision of diagnosis in both diseases remains a problem.[3,4]. The differential diagnosis of COPD and asthma rests on differences in clinical presentation, triggering factors, and on demonstration of airflow obstruction. This airflow obstruction is not fully reversible in COPD, whereas it is in asthma. Asthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment
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