Alternative diagnoses to COPD

When a clinician is presented with the risk factors, symptoms and signs of COPD, it is within the remit of the primary care clinician to confidently reach a diagnosis of COPD using their own practice and network resources in the majority of cases. 

Any person suspected to have a diagnosis of COPD should have, as a minimum, a chest x-ray (performed within the last 3 months) and a recent full blood count (FBC) as multi-morbidity is common in people at risk for COPD.   

The PCRS has two policy documents that can support an approach to aid the consideration and improve pick up of other, less common causes. These are the  differential diagnosis of the breathless patient and the diagnostic service specification.

In recent years audits of COPD care within the UK have shown that the early and accurate diagnosis of COPD needs more resource and attention. There is evidence of both over and under diagnosis. PCRS advocates for a comprehensive assessment of symptoms and signs that ensures all causes are considered as COPD does not usually exists as a single long-term condition in any person. 

What you need to know

Following the advice set out in  Managing cough in primary care and the  Differential diagnosis of the breathless patient can help you follow a structured approach that helps you to ensure that other conditions are considered.   

How to do it

The PCRS Diagnostic Service Specification is a helpful tool to use for systems that are trying to set up comprehensive and structured network services for diagnosing people with respiratory symptoms. The individual clinician can be supported in think beyond asthma, COPD and infection as causes of respiratory symptoms by having a clear easy to negotiate structure that allows the right tests and sometimes a more specialist view of the results when COPD doesn’t quite fit. 

Personalising Care 

A member of the PCRS Patient Reference Group, Barbara Preston provided a personal perspective on the impact of a late diagnosis of bronchiectasis. Patient and clinician stories about the impact of missed or late diagnosis can be powerful and informative and add a new dimension to help trigger diagnosticians to think more broadly when considering a diagnosis of COPD.