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Lung disease diagnosis confusion

(BBC 19/11/2008)

COPD and asthma patients may have to be re-tested. A poll of 776 UK GPs by the British Lung Foundation coincides with an audit which finds COPD care in England often falls short. COPD, an umbrella term including chronic bronchitis and emphysema, is the fifth biggest killer in the UK. The survey found that 80% of doctors found differentiating between asthma and COPD quite or very challenging.

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  • Posted

    Hi Jacee,

    I totally agree with you!

    My mother had been complaining for months about her chest & breathing. In the end her GP didn’t know what to do so referred he her to the \"Dart\" clinic at the local hospital.

    After spending 6 hours there the doctor told her she had Asthma & gave her a prescription for Ventolin & another inhaler. The pharmacist gave her the Ventolin & told her she could only use it 4 times a week & told her that she couldn’t have the other inhaler as she would have to see how she got on with the Ventolin & if she needed something else to go back to her GP.

    I got her an aero chamber as with her Arthritis I could see she couldn’t hold & squeeze the Ventolin & inhale in time for it to work. I also explained she could use it more than 4 times a week!

    (I have been told by my BLF nurse to put 4 puffs in my aero chamber at a time & inhale slowly & this will act like a nebuliser)

    Within 4 days I was so worried as her lips were slightly blue, her breathing was even worse & her Sats were down to 91 that I rushed her to A & E & she was then diagnosed with COPD!!

    Her GP has now prescribed Flixotide & she has a Spirometry test booked for next week.

    I am lucky that I am with a different practice, although I remember when I was 1st being treated my Spirometry nurse said she couldn’t understand why my breathing was deteriorating so fast with Asthma! It was then that I told her I had the Alpha 1 Anti-trypsin deficiency & she said \"Oh right so you have COPD!!\"

    Take Care, Knitty x

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  • Posted

    Hi jacee, Knitty,

    I couldn't agree with you more. I have never yet had two doc's or respiratory nurses give the same advice / prognosis or answer to a question. Most of the time since diagnosis, I have needed to tell them what might be wrong and suggest the action they should take. Had I not done this I would still be on just my ventolin plus an anti-cholingeric inhaler. I would not have been sent for a chest X ray, would not have had a blood test for Polycythemia (which showed me as borderline), would not have been offered pulmonary rehab (I had to suggest it to them), would not have been tested for O2 - or given 02. I also asked my GP a year ago to test me for Alpha1 as I was reasonably sure I had it. I was told that was most unlikely - even though I told them of my brothers' childhood liver disease and pointed out that evidence of emphysema in both upper and lower lobes was suggestive of Alpha. This year at oxygen clinic I was TOLD by another Doc that from my notes etc he would suspect Alpha and so I was tested and proved positive. Oh - I also had to remind my GP that I should have an annual 'flu jab and asked for the pneumonia jab as that wasn't happening either.

    I had never heard of COPD 18 months ago, so I'm no expert. I only knew what care I should be receiving because I read a couple of COPD books plus the NICE guidelines and visited various internet sites.

    It is because of all the above that it gets my goat a bit when people keep warning not to do this or that 'without your GP's advice'. If I stuck with what the Doc's advised, my prognosis would have been seriously adversely affected!

    :roll:

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  • Posted

    Hi

    That's what I find too Van, that I have to \"read up and chase up\" to make things happen.

    When you look at the differences:

    \"Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction, and bronchospasm. Symptoms include wheezing, cough, chest tightness, and shortness of breath. Attacks can be prevented by avoiding triggering factors such as allergens or rapid temperature changes and through drug treatment such as inhaled corticosteroids.\" Wikipedia

    Compare this to COPD, which is a chronic disease of the lungs, where there is rarely a wheeze, and where conditions are constant and worsening rather than \"variable and recurring\". The poor airflow to the lungs is NOT reversible and, whilst there can be exacerbations, there are no \"attacks\" to try and \"prevent\".

    How anyone with a modicum of medical training can confuse the two is hard to understand, particularly in such large numbers (80%!!!!).

    When you consider recent (and older) posts where people are unsure of the diagnosis they have been given (you only have to look at my son's experience) it is absolutely appalling and shows just how important it is to take control for yourself, to arm yourself with knowledge and to develop the ability to speak out when you need to. It really makes one appreciate the knowledge and support available on this site. Thank you to you all. :D

    Jacee

    xx

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  • Posted

    hiya all, i also had never heard of copd until my mum was diagnosed with it 3 yrs ago. now i work with a lady who has just been told she has it, and a customer, who comes in our pub, told me that his ex wife died on friday just gone, COPD was the cause of her death, she was 42 yrs old. he didnt have a clue what it was, he thought it was a form of cancer. I cant believe the amount of people who have been diagnosed with this illness. Its scary. Hope you are all taking good care x talk soon xkarenxxx
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  • Posted

    Hi Knitty, don't want to alarm you, but I was unfamiliar with the inhaler your mum was prescribed so looked it up and guess what? It is prescribed for asthma.

    \"WHAT IS IT?

    Flixotide evohaler, accuhaler, diskhaler and nebules all contain the active ingredient fluticasone propionate, which is a type of medicine known as a corticosteroid.

    Fluticasone is a synthetic corticosteroid and is used to decrease inflammation in the lungs. When inhaled into the lungs it is absorbed into the cells of the lungs and airways. Here it works by preventing the release of certain chemicals from the cells. These chemicals are important in the immune system and are normally involved in producing immune and allergic responses that result in inflammation. By decreasing the release of these chemicals in the lungs and airways, inflammation is reduced.

    In asthma, the airways tighten due to inflammation and can also be blocked by mucus. This makes it difficult for air to get in and out of the lungs. By preventing the inflammation and excess mucus formation, fluticasone helps prevent asthma attacks. It is not used to treat an asthma attack.

    Fluticasone is taken using an inhaler device to treat asthma. Inhaling the medicine delivers it directly to the lungs where it is needed. It also reduces the potential for side effects occurring in other parts of the body, as the amount of medicine absorbed into the blood from the lungs is lower than if it was taken by mouth. Flixotide is available as three different types of inhaler device: a chlorofluorocarbons (CFC) free metered dose inhaler called the evohaler, and the breath-actuated accuhaler and diskhaler. Flixotide nebules are used with a machine called a nebuliser that converts the liquid medicine inside the nebules into particles that can be inhaled. It is used to deliver higher doses of the medicine than other inhalers.

    Fluticasone taken by inhalation is known as a 'preventer'. This is because it is taken regularly every day to reduce the inflammation in the lungs and prevent asthma attacks. Symptoms usually start to get better between four to seven days after starting treatment. However, it is important to keep using this medicine regularly, even after your asthma symptoms have improved, in order to prevent them coming back.

    WHAT IS IT USED FOR?

    * Asthma.\"

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  • Posted

    Hi people, Just read your posts - re: the righthand does'nt know what the left hand is doing! You can say that again. I have been in hospital on manY occasions over the years I am never under the same Consultant, each has thei rown idea how to treat me , quite often very differently. Some say I have asthma as well as copd and bronchiectasis. On one occasion I went in as an emergency-waited nearly 4 hours to see a doctor by which time I was barely breathing but because I don't make a fuss they left me to it! I've learnt to lay it oN the line or you get nowhere. I was tolD to take 40mg. oF prednisolone , o.k. but I had aready tsken 40mg. - they never bothered to check, I told them, oh dear we are sorry, 80mg. and I would have been in real trouble! Another time I was given someone else's drugs. Just as well I have my wits ab out me still. I make sure I take all my pills in with me and I tell the staff I am self~medicating and I check anything extra throughly. I always read the discharge letter as it is often wrong or missing some drugs. Ihave been on my present tablets for maybe a couple of years and am never checked to see if I still need the same dosage. Must go back to my g.p. who is very good to me overall and go through it him. Overall I have no major issue with the N.h.S. AND LONG AS i KEEP A CAREFUL EYE ON WHATS GOING ON. lONG MAY i KEEP MY MARBLES IF NOT MY BODY. CHEERS TO U ALL.
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  • Posted

    You are right cats and dogs, the NHS is a good and reliable source of help generally but COPD is an area which seems to be little understood. For example, I think the pulmonary rehabilitation stuff is working for me; I feel better for going, and not just because it gets me out. I am also doing the exercises at home (alongside my son) and feel stronger, though my muscles really ache at times! However, we had a talk from an OT nurse on Thursday, where she talked about relaxation (which was helpful) and using it to \"slow down\" our breathing during \"an attack\" (which was not, as we may need to control our breathing at times but none of us has asthma and therefore do not have \"attacks\"wink.  If the nurses at my rehab class cannot distinguish COPD from asthma I shall revert to my first post and state \"God help us all\"!

    Jacee

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  • Posted

    On the same subject - I just remembered, when I was last in hospital (March, because my SOB had worsened) the doctor on the ward said he was prescribing antibiotics and steroids for me. I asked him why and he said to treat my chest infection. I told him I had no temperature, no wheeze and what little sputum I was coughing up was clear. He then said the antibiotics were being prescribed as a PREVENTATIVE!!!!!!!!!! We all know (or should) that antibiotics don't work this way, they are of no use whatsoever if there is no infection for them to fight. Also, over-prescribing antibiotics is counter-productive as we develop an immunity to them and then they no longer work when we need them to. Needless to say I refused to take them. He then thought I was an \"awkward patient\" and sent for the head respiratory nurse who came to see me. She did not challenge him but quietly told me not to take them and then, at me request, recommended I was discharged. I was - with no medication to take home, as none was needed.

    Jacee

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