3. Mr R complains the Practice incorrectly told him he had chronic obstructive pulmonary disease (COPD) and emphysema in April 2021. Mr R said he only found out in May 2024 that his correct diagnosis was asthma.
4. Mr R says the experience has affected his mental health and he has suffered depression and anxiety from believing he had COPD and emphysema.
5. Mr R would like the Practice to pay him a financial remedy for the distress he has suffered.
6. Mr R attended an appointment at the Practice in April 2021 with several problems including a lump in his throat and decreasing weight.
7. The Practice referred Mr R for a chest X-ray. The results of the X-ray showed that Mr R’s ‘lungs were hyperinflated, in keeping with emphysema, but no focal active lung lesion is seen’.
8. The Practice added a diagnosis of emphysema to Mr R’s records and sent a referral for spirometry (lung testing). The spirometry results from November 2021 confirmed a diagnosis of asthma was likely. The Practice prescribed Mr R with a preventer and reliever inhaler and he continued to have regular reviews for COPD/emphysema over the following years.
9. In May 2024, Mr R said he found out from the Practice that he did not have emphysema and instead had asthma.
14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications the Practice has done anything wrong.
15. Mr R said the Practice incorrectly told him he had COPD/emphysema, and he believed he had this for several years.
16. The Practice said Mr R has a multifactorial cough (asthma, reflux and post-nasal drip) which has been diagnosed by the respiratory team and confirmed with spirometry as asthma. It said a chest X-ray and CT scan have both reported emphysema.
17. The Practice said it is likely there is an element of both diagnoses.
18. The results from Mr R’s X-ray in May 2021 were labelled as emphysema changes, and the Practice then coded this on the problem list on Mr R’s records.
19. Our GP adviser said it may have been slightly premature for the Practice to enter this in the records before the lung tests which are needed to confirm a diagnosis.
20. Once the spirometry had confirmed Mr R’s symptoms were more in line with asthma in November 2021, the Practice included this diagnosis in the records. There is then a documented conversation in the records that shows the Practice spoke to Mr R and communicated this diagnosis to him. The records state Mr R was surprised by the diagnosis.
21. GMC Good medical practice that was in place at the time says to communicate effectively, doctors must:
‘share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties.’
22. We understand Mr R’s view that he was unaware of the update in the diagnosis and continued to believe he had COPD or emphysema over the following years. We do not have access to a recording of the conversation that would enable us to make sure Mr R fully understood, but based on the evidence we have seen, the Practice communicated the asthma diagnosis in line with good medical practice.
23. Over the following months and years, the Practice continued to treat Mr R’s asthma. It prescribed him with a preventer and reliever inhaler and arranged an annual review. At the first annual review in February 2023, staff observed Mr R using his inhaler and noted he was not getting sufficient relief. The Practice then changed Mr R’s prescription to a stronger inhaler.
24. NICE guidelines on asthma management recommend clinicians observe patients using their inhaler device to check if they can use it properly, and if possible, prescribe the same type of device to deliver preventer and reliever treatments where more than one inhaler is needed.
25. Our adviser said the Practice was treating Mr R for asthma over this period in line with NICE guidelines. We have seen no indication the Practice was not treating Mr R’s symptoms appropriately.
26. We recognise Mr R is confused as the Practice has still listed COPD/emphysema as a possible diagnosis and explained in its response that there may be an element of both diagnoses.
27. NICE guidelines on COPD say to suspect a diagnosis of COPD in people over 35 who have a risk factor (generally smoking or a history of smoking) and who present with one or more of the following symptoms:
• exertional breathlessness • chronic cough • regular sputum production • frequent winter bronchitis • wheeze.
28. Additionally, these guidelines explain asthma is a differential diagnosis of COPD, which means they can be difficult to distinguish clinically and may co-exist.
29. Our adviser said it was correct in line with the guidelines for the Practice to suspect a diagnosis of COPD based on Mr R’s symptoms and risk factors, and even though the lung tests confirmed Mr R’s primary diagnosis was asthma, the two conditions can overlap.
30. For this reason, since 2021, the Practice has been carrying out annual COPD reviews to monitor Mr R’s symptoms.
31. We understand Mr R has been worried about his diagnosis and it has caused him anxiety. We consider the Practice has acted correctly in line with relevant standards and guidelines in diagnosing and treating his symptoms and communicating his diagnosis.
1. We have carefully considered Mr R’s complaint about the Practice. We understand Mr R was confused about his diagnosis and says the experience has affected his mental health. We are sorry to hear this experience worried Mr R and left him feeling uncertain about his overall health.
2. We have seen no indications the Practice has done anything wrong in communicating Mr R’s diagnosis and treating his condition.