According to the authors of an article published in The BMJ on July 1, 2015, the Global Initiative for Obstructive Lung Disease (GOLD) criteria for COPD diagnosis result in significant overdiagnosis and overprescription of inhalers, especially in older men, and should be modified.
Martin Miller of the University of Birmingham and Mark Levy of the Harrow Clinical Commissioning Group write that using the GOLD definition results in an estimate that 22% of the over-40 population in England and Wales meet the criteria for airflow obstruction, while lower limits of normal (LLN) criteria estimate the prevalence at 13%. They say that the GOLD definition fails to identify approximately 13% of cases of airway obstruction, primarily in younger women.
Noting that many of the patients misdiagnosed with COPD have cardiac disease, Miller and Levy note that the prescription of inhaled anticholinergics to these patients could be exposing them to risk of death for no reason and suggest that, “The unexpected mortality arising from use of these drugs may be due to the fact they are being given to patients with heart disease who have COPD misdiagnosed with the GOLD criteria.”
The authors say that the GOLD strategy documents for COPD and the NiCE guidelines that include the GOLD criteria should be changed and that clinicians should use LLN instead of GOLD to diagnose COPD.
Read the BMJ article.
