Experts call for a holistic approach to COPD assessment
GPs and practice nurses should not diagnose the severity of chronic obstructive pulmonary disease (COPD) based on measurements of airflow alone, but should consider other factors such as breathlessness and BMI, leading lung experts have said.
It is estimated that 3 million people have COPD in the UK, although this number is likely to be higher as many people remain undiagnosed.
The call reiterates the updated COPD guidance from NICE which warns that disability in COPD can be poorly reflected by FEV1, a measure of airflow severity.
Updated in June this year, the guidance now recommends a more comprehensive assessment of COPD severity that includes the degree of airflow obstruction and disability, the frequency of exacerbations and a number of known predictive factors.
These factors can be measured using the BODE index (BMI, airflow obstruction, dyspnoea and exercise capacity using the 6 minute walking test), where the information is available.
Speaking at a conference on COPD at the Royal College of Physicians yesterday, Dr Kevin Gruffydd-Jones, a member of the NICE COPD Guidelines Committee and a GP in Bath, urged primary care staff to measure BODE.
It is a better predictor of COPD exacerbations at 5 years than FEV1 and is better at predicting hospitalisation and mortality up to 3 years post follow-up, he said.
“It is not just about measuring airflow. It is about using multi-dimensional assessment tools like BODE, which is tried and tested, and taking a more holistic assessment of COPD.
“This can ensure that the assessment leads to good management so that patients can lead a long and healthy life.”
Dr Gruffydd-Jones added that the NICE guidance on COPD had helped to boost the profile of the disease.
“One of the reasons that COPD was long considered a Cinderella subject was that we didn't know what to do with it. The introduction of the NICE COPD guideline in 2004 was brilliant and has helped to improve treatment of COPD. The updated guidance builds on this,” he said.
Replacing the original NICE guideline on COPD, the updated guideline makes a series of new recommendations based on the best evidence currently available.
The partially updated guideline focuses particularly on diagnosis, severity classification, managing stable COPD and disease progression.
Clear guidance is given on the sequencing and combination of inhaled therapies to achieve the best clinical and health economic outcomes based on persistence of symptoms and severity of airflow obstruction.
11 November 2010