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PLYMOUTH COPD AUDIT – ACCURACY OF DIAGNOSTIC REGISTERS
Rupert Jones1, Janet Comyn1, Bryanie Shackell1, Rowan Russell2 Addresses: 1. Respiratory Research Unit, Peninsula Medical School, N21 ITTC Building, 1 Davy Road, Plymouth, PL6 8BX 2. Plymouth Teaching Primary Care Trust, Building One, Derriford Business Park, Brest Road Plymouth, PL6 5QZ
Background The diagnosis of COPD is made using clinical features and spirometry. Problems with performing and interpreting spirometry would suggest that diagnostic registers for COPD in primary care may be inaccurate. Methods A visiting expert nurse examined the clinical records of patients on primary care COPD registers in 14 practices in Plymouth. Suitable patients were assessed comprehensively including spirometry, with reversibility testing if clinically indicated. Results The registers held 919 patients with COPD, after excluding those with coding errors, normal spirometry and those unable to attend, 620 were invited. Of 382 seen, 33 were unable to perform spirometry: obstructive 287 (82%); normal spirometry 47 (13%); restrictive 15 (4%). Of those with obstruction, 85/287 (30%) underwent reversibility testing: 13/85 (15%) reversed to normal. 21/85 (25%) had asthma alone, 5/85 (6%) had mixed COPD and asthma, and 59/85 (69%) had COPD alone. Thus 266 had spirometrically confirmed COPD out of 349 assessed (76%). COPD severity grading was 54% mild, 37% moderate, 9% severe. Discussion COPD registers are inaccurate, after excluding those with coding errors, 24% of assessed patients did not have COPD. Reversibility testing excluded the diagnosis of COPD in 13/85 (15%), and in 13/287 (5%) of all patients with obstructive spirometry.
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