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The Diagnostic and Prognostic Value of the Symptom of Shortness of Breath in Primary Care: A Cohort Study

Background

When a patient consults their GP, the GP may record a symptom (e.g. shortness of breath) rather than a diagnosis (e.g. asthma) in the patient’s computerised record. This may happen if the GP regards a symptom as representing a self-limiting illness, or the diagnosis is not clear at the time of an initial consultation.

 Complaints of breathlessness and wheeze are common reasons why patients consult their GP, and may simply be a short-term and minor problem, or could be an early sign of chronic obstructive pulmonary disease (COPD), asthma, or ischaemic heart disease (IHD). The similarity of symptoms related to these conditions may make their diagnosis at initial presentation difficult, and often requires a number of tests.

 The study

This was a study of adults aged ≥18 years, performed within the Clinical Practice Research Datalink (CPRD) – a database drawing on GP records in England.

 Results

In this study, we found a much higher rate of COPD, asthma and IHD diagnosis in the next six months in patients presenting with an undiagnosed breathlessness/wheeze symptom for the first time compared to patients without a recorded breathlessness or wheeze symptom. This suggests these symptoms are strong markers that helped GPs to make a diagnosis. However, there were still higher rates of COPD, asthma and IHD diagnosed after the first six month period. We think this increased rate may be partly explained by some in diagnosis.

 Some patients were initially prescribed drugs relevant to their future diagnosis despite the notes not having a diagnosis label recorded, but two-thirds of patients did not receive potentially appropriate medication in the initial six months after presenting with a breathlessness or wheeze symptom. This may represent a missed opportunity for early management.

 Patients who received no relevant management in the first six months still had noticeably increased risks of COPD, asthma, and IHD. Furthermore, it was found that patients with a breathlessness or wheeze symptom had increased death rates.

 Conclusions

These findings suggest that presentation to primary care of breathlessness and wheeze can be an early indicator of later diagnoses of asthma, COPD and IHD, and also an indicator for earlier mortality.

 Primary Care clinicians should consider more targeted investigations, monitoring and follow-up when patients initially present with symptoms of wheeze or breathlessness, to ensure accurate diagnosis, appropriate management and health and lifestyle advice are given to patients as early as possible.

 Patient and Public Involvement and Engagement (PPIE)

We held a number of PPIE meetings, members from the local ‘Breathe-Easy’ group, where the study idea, analysis and results were discussed. The study team is very grateful for the contribution of the PPIE group.

 Outputs

· Two papers are in preparation for submission to academic journals

· Two presentations of the results have been made at academic conferences (Society for Academic Primary Care, 206 and 2017)

· Summary of results sent to local Clinical Commissioning Groups (as suggested by the PPIE group)

 

 

Tue 10 Oct 2017, 13:43 | Tags: Study Results