Tens of thousands of people in England have chronic obstructive pulmonary disease (COPD) and don’t know it, the British Lung Foundation (BLF) has warned, as it reveals that diagnosis rates have dropped by half in the last year and calls for better access to diagnostic tests and care for people with the condition ahead of World COPD Day tomorrow (17th November).
Failing on the Fundamentals: insights from those living with chronic obstructive pulmonary disease (COPD) around the UK, which includes the results of the largest ever survey of people with COPD in the UK (8,000 people), reveals new analysis that suggests as many as 46,000 people in England have symptoms of COPD, in the last year, such as breathlessness, coughing and wheezing, but may not have been diagnosed.
This is likely to be due to a combination of factors, says the BLF, including essential diagnostic breathing tests being suspended because of fears around the spread of COVID-19, long waits to see specialists, as well as low public awareness of COPD and its symptoms and misconceptions that the disease only affects older people and those who have smoked.
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COPD is usually caused by long-term damage to the lungs from breathing in a harmful substance, usually cigarette smoke, but also exposure to air pollution or occupational exposure to harmful fumes or dust.
To get an accurate diagnosis of COPD, people should have spirometry testing and be asked about smoking, work and lifestyle history, which requires patients to be able to get an appointment with their GP or respiratory nurse. However, in March 2020, GPs were advised by NHS England to suspend using spirometry because of fears around the spread of COVID-19 at the beginning of the pandemic. The charity says this, coupled with difficulty in people getting appointments, could account for the 51% drop compared to those diagnosed in 2019.
The growing numbers of undiagnosed people with COPD is a ticking time bomb for the NHS. … It is vital that the NHS urgently ensures that GPs are supported to deliver life-saving diagnostic testing right now to start to address the backlog of undiagnosed patients.
— Sarah Woolnough,
Chief Executive at the British Lung Foundation
According to the BLF report, even before the pandemic, almost three quarters (70%) of people who have been diagnosed with COPD said they faced barriers in getting their diagnosis. Almost one in 10 (9%) said they had difficulty getting a GP appointment and a similar proportion 7% said they had been unable to get a diagnostic test.
The BLF says it is likely many people with COPD are also going undiagnosed because there is a general lack of awareness about symptoms amongst patients and healthcare professionals. Breathlessness and coughing can be symptoms of Long COVID, asthma or lung cancer as well as COPD. There is also a misconception that COPD only affects older people and those with a history of smoking, but the report reveals that:
- One in five people (21%) who have been diagnosed with the condition had symptoms when they were under the age of 45.
- One in 10 people with the condition – around 130,000 – have never smoked.
- More than half (55%) waited at least six months to speak to their GP about their symptoms.
- More than one in six (17%) waited more than two years to speak to their GP about their symptoms.
- One in five people (22%) who have been diagnosed with COPD say their symptoms were initially mistaken for a chest infection or cough.
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The BLF points out that earlier diagnosis means the rate of decline in lung function can be slowed and symptoms can be addressed through good self-management, medication and pulmonary rehabilitation, helping people to maintain their quality of life.
Call for better access to diagnostic tests
The British Lung Foundation is calling for health services across the UK to tackle the diagnostic backlog by urgently restarting spirometry testing and for increased awareness of COPD and its signs and symptoms.
It adds that plans for new Community Diagnostic Centres in England should improve COPD diagnosis in the long run, but these could take years to be fully established. “In the meantime, GPs should be practically supported now to deliver spirometry testing and there must be government funding to help address issues with capacity,” says the BLF, adding that “the NHS cannot afford to leave people without a diagnosis and see their symptoms and wellbeing deteriorate”.
We need to make a concerted effort to find people who have COPD and offer them the treatment they need. … We need to make sure that GPs are looking at people’s health records and calling them in if they have been for repeated visits for cough or breathlessness and its essential that they use spirometry to make an accurate diagnosis.
—Alison Cook, Director of External Affairs at Asthma UK and
Chair of the Taskforce for Lung Health
The British Lung Foundation is also urging people who are concerned about their breathlessness to take a breath test on the British Lung Foundation website, which will advise whether they should book an appointment with their GP about their symptoms.