Trials show the benefits of diagnosing conditions early

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Experts say diagnosing asthma and COPD early is crucial. Bingdian/Getty Images
  • Researchers report that as many as 70% of people with chronic obstructive pulmonary disease (COPD) or asthma may be undiagnosed.
  • They say receiving a diagnosis and treatment can dramatically improve the health and quality of life of someone with one of these conditions.
  • They add that people should take respiratory symptoms seriously and consult a doctor and request a spirometry test if they have any concerns.

The next time you go to the doctor, ask him or her to check your breathing, especially if you’ve been experiencing even minor problems.

Nearly seven in 10 people with asthma or chronic obstructive pulmonary disease (COPD) are undiagnosed, a situation that can lead to poorer long-term health outcomes and lower quality of life than if someone had been diagnosed and treated earlier, shows a new study published in the New England Journal of Medicine reports.

This study is the first of its kind to look not only at diagnosis rates for asthma and COPD, but also at the effects of early treatment and diagnosis on quality of life and burden on the healthcare system.

“I am a practicing pulmonologist and I see many people who come to my practice who have been experiencing symptoms of asthma or COPD for months to years, and have not yet been diagnosed,” says Dr. Shawn Aaron, a lead study author, respirologist and senior scientist at the Ottawa Hospital Research Institute and professor at the University of Ottawa in Canada, said Medical news today.

“So we did this study where we looked at people who we diagnosed, with no history of asthma or COPD, and we diagnosed them,” he explained. “We found that those who have not been diagnosed with COPD or asthma, compared to people their age, have a much poorer quality of life. They have reduced work performance and reduced attendance at work because they take days off due to their respiratory symptoms. These are people who are suffering more or less in silence because they don’t go to their doctors, or because their doctors don’t make the right diagnosis.”

Researchers surveyed more than 26,000 people about shortness of breath and lung function, finding a group of 595 asthma and COPD diagnoses, which were confirmed using a gold standard spirometry test.

Of this group, 508 agreed to participate in a clinical trial in which half received typical clinical care for these conditions and the other half regularly visited a pulmonologist.

Both groups received help: 92% of those who went to pulmonologists received new medications to treat the conditions, as did 60% of those who received usual care.

Those who visited lung specialists went to the doctor less often the following year (0.53 compared to 1.12 per participant) and had greater improvements on the St. George’s Respiratory Questionnaire (10 point increase compared to less than 7) compared to their counterparts that Usual care.

Researchers reported that both groups also improved much more than if they had remained undiagnosed. They said that a four-point improvement on the respiratory questionnaire represents a significant increase in the health and quality of life that each study group experienced.

“Overall, these results are inspiring,” said Dr. Robert Jasmer, a pulmonologist at Pulmonary Associates of Burlingame, California, who was not involved in the study.

“Given the specialized training and experience we as pulmonologists have with patients with asthma and COPD, it was nice to see the benefits of diagnosis and early treatment confirmed in a community-based study published in a prestigious medical journal,” said Jasmer. Medical news today.

On some level, the findings of this study are common sense. Of course, people with undiagnosed medical conditions do better after receiving a diagnosis.

Beneath that, however, lies the more pressing question of why so many people go undiagnosed with serious respiratory illnesses.

The answer is multi-faceted, but one reason, especially when it comes to COPD, is that people develop it later in life, making the symptoms easier to ignore until they develop into an undeniable condition, Aaron says.

“You usually don’t start developing COPD until you’re in your 60s,” he said. “Many people who start to develop COPD become increasingly short of breath, and the shortness of breath is progressive, decreasing with more shortness of breath every month or two or three. Maybe they deny it or just think they’re getting older.’

Doctors can also perpetuate this dynamic.

“Sometimes the doctor will wave away the symptoms and signs and say, ‘Oh yeah, you’re 65 now, we expect you to be a little short of breath,’” Aaron said. “Sometimes the doctor has good intentions, but does not make the diagnosis.”

Patient self-help can help.

“If you have a long-lasting cough that doesn’t go away after eight weeks, or if you have wheezing or tightness in your chest – this is not normal. And you shouldn’t assume that everything is fine,” Aaron said. “You should go to your doctor and insist that the doctor order a spirometry test for you. What I would tell the public, because now we know that if we find this and treat it, you will get better.”

Jasmer echoed that sentiment.

“This study is important because for most of my training and career there has been a lot of negativity around COPD, especially because it is a hopeless end-stage disease for which treatment does not help – that is not correct, so COPD mainly suffers from big PR problem,” he said. “The public perception that COPD is untreatable is not true and asthma is almost completely treatable and usually completely reversible. Although patients with COPD can help their symptoms through lifestyle changes such as quitting smoking and exercising, there are still many other effective medical treatments available that they can discuss with their doctor to further improve their symptoms, which will also improve their quality of life. life will improve.