Respiratory experts emphasized the continuing under-diagnosis of chronic obstructive pulmonary disease (COPD) at a European conference last week.

They highlighted the size of the problem, why it might exist, and what can be done to address it in sessions at Clinical Consensus in COPD, held in London, UK on 2–3 March.

Bart Celli (Tufts University, Boston, Massachusetts, USA) told delegates that COPD is the only major cause of death that is increasing. COPD is currently the fourth leading cause of death in the USA, and yet it remains under-diagnosed, he said.

Sonia Buist (Oregon Health & Science University, Portland, USA) agreed, saying: "There continues to be a disconnect between the perception of the prevalence of COPD among primary care providers and estimates obtained from population-based surveys."

Recent surveys estimate that up to a quarter of adults aged 40 years and older have Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I airflow limitation or worse, but less than 6% of the population have been told they have COPD, she explained.

C P van Schayck (University of Maastricht, The Netherlands) pointed out that under-diagnosis leads to under-treatment and could play an "important role" in the morbidity and mortality from COPD.

She said that the main reason underlying under-diagnosis "is under presentation by patients." This is partly due to patients under-perceiving their symptoms, but also due to cognitive dissonance, she claimed.

"They simply deny they have symptoms," she said. She explained that some patients think: "It's just a smoker's cough."

Celli also said that spirometry is under-used. "Our mission is to preach this test and continually hammer it," he urged.

Meeting website