Misdiagnoses of COPD can occur due to similarities with other lung conditions or a lack of symptoms in the early phase.

Chronic obstructive pulmonary disease (COPD) is a major disease, but its diagnosis isn’t always straightforward. Misdiagnoses and missed diagnoses are common, potentially leading to inappropriate treatments and disease progression.

Let’s explore the reasons for these challenges, common conditions mistaken for COPD, and the importance of seeking a second opinion if you have doubts about your diagnosis or treatment.

COPD is a progressive lung condition that obstructs airflow, making breathing difficult. It typically causes coughing with large amounts of mucus, shortness of breath, chest tightness, and other symptoms.

COPD refers to two main conditions: emphysema, which damages the air sac walls in the lungs, and chronic bronchitis, which involves airway irritation and mucus buildup. Most people with COPD have a mix of both conditions.

COPD affects about 16 million adults in the United States, with more females diagnosed than males. It’s a leading cause of disability and the sixth leading cause of death in the United States. Smoking is a primary cause, but air pollution and genetics also play a role.

COPD is frequently underdiagnosed or misdiagnosed, with underdiagnosis rates varying from 10–95% and overdiagnosis rates from 5–60% worldwide.

The burden of obstructive lung disease (BOLD) study in Australia showed that 1.8% of adults had confirmed COPD, but only half were aware of their diagnosis. Another 6.9% likely had COPD but were undiagnosed.

As per the study, to find undiagnosed COPD, medical health professionals should focus on people ages 60 years and older, especially those ages 75 years and older with wheezing, shortness of breath, and lower BMI.

For identifying and reviewing misdiagnosed COPD, the study recommends that doctors look at females under the age of 60 years with no wheezing and a higher BMI.

What causes misdiagnosis?

Research suggests that misdiagnosis may occur because of the following:

  • Inconsistent diagnostic criteria: Varying criteria for diagnosing COPD, such as different spirometric parameters, can lead to missed diagnoses.
  • Underutilization of spirometry: Not using spirometry, which is essential for diagnosing COPD, can result in missed cases.
  • Education: Lack of education may lead to less awareness of COPD symptoms, and less access to healthcare may result in missed diagnoses.
  • Age: Older age groups may attribute symptoms of COPD, such as breathlessness to aging rather than seeking medical attention, resulting in missed diagnoses.
  • Language barriers: Language barriers can hinder effective communication between people with COPD and healthcare professionals, leading to missed opportunities for diagnosing COPD.
  • Coexistent diseases: Other conditions, such as asthma, bronchiectasis, heart failure, and previously treated tuberculosis, can present with similar symptoms to COPD, leading to misdiagnosis or missed diagnosis.

Misdiagnoses of COPD can occur as other conditions, such as asthma, heart failure, or bronchiectasis, due to similarities in symptoms like shortness of breath and coughing.

Conversely, these conditions can sometimes be mistaken for COPD. These diagnostic challenges emphasize the importance of a thorough differential diagnosis process to ensure an accurate diagnosis.

Here are some disorders that could mimic COPD:

  • Asthma: Asthma and COPD share some similar symptoms, such as shortness of breath and wheezing. However, asthma typically involves reversible airflow obstruction, while COPD does not.
  • Heart failure: Heart failure can cause symptoms similar to COPD, such as shortness of breath and fatigue. The distinction is important because the treatment approaches differ.
  • Bronchiectasis: Bronchiectasis is a condition that involves unusual widening of the airways, leading to chronic (long-term) cough and sputum production, similar to COPD.
  • Pulmonary embolism: Pulmonary embolism (PE) can present with symptoms similar to COPD, such as shortness of breath and chest pain. PE requires immediate medical attention and can be life threatening.
  • Lung cancer: Lung cancer can mimic COPD symptoms, especially if it obstructs the airways. Imaging studies such as chest X-rays or CT scans help differentiate between the two conditions.

What happens if COPD is misdiagnosed or undiagnosed?

Misdiagnosis can lead to individuals being over-treated with costly and potentially ineffective medications, ultimately affecting their quality of life.

If COPD remains undiagnosed and untreated, it can result in disease progression, affecting quality of life and leading to preventable exacerbations.

Undiagnosed individuals may also miss out on opportunities for support and interventions, such as smoking cessation programs, that could help manage their condition.

Seeking a second opinion for COPD is a good idea if you have concerns about the diagnosis or the treatment or you don’t see any reduction in your symptoms. Another healthcare professional may offer a different perspective, additional treatment options, or confirm the initial diagnosis.

When seeking a second opinion, research a doctor or pulmonologist with expertise in COPD. Bring your medical records to the appointment and discuss your concerns openly. Carefully consider the recommendations and decide on the best course of action.

COPD is frequently misdiagnosed or undiagnosed, largely due to overlapping symptoms with other conditions and limited access to spirometry in some areas. Seeking a second opinion can provide valuable insights and alternative treatment options.

Researching specialists, gathering medical records, and openly discussing concerns during the consultation are essential steps to ensure accurate diagnosis and effective management of COPD. Seeking a second opinion on your diagnosis may help if you feel that the current treatment is not working or you have any unaddressed concerns.