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Comparative Study
. 2025 Jan 22;12(1):e002708.
doi: 10.1136/bmjresp-2024-002708.

Twelve barriers to COPD diagnosis in France: a comparative qualitative study

Guillaume Roucoux  1 , Elisabetta Scanferla  2   3 , Mathieu Delorme  4   5 , Laurie Fraticelli  6 , Lize Kiakouama Maleka  7 , Cécilia Nocent-Ejnaini  8 , Annaig Ozier  9 , Maxime Patout  10 , Olivier Le Rouzic  11   12 , Maéva Zysman  13 ; ABCD Study Group
Collaborators, Affiliations
Comparative Study

Twelve barriers to COPD diagnosis in France: a comparative qualitative study

Guillaume Roucoux et al. BMJ Open Respir Res. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a common treatable disease often diagnosed in patients with risk factors after a prolonged period with suggestive symptoms. Our qualitative study aimed to identify barriers to establishing diagnosis in the natural history of this condition.

Methods: An inductive thematic analysis was performed on structured interviews with patients, general practitioners (GPs) and pulmonologists in France. Inclusion depended on criteria to generate two purposive samples (patients and physicians). Recruitment occurred online. Data collection proceeded until 15 patients and 15 physicians (eight pulmonologists, seven GPs) were interviewed. Data saturation was checked and achieved. The interviews were transcribed and coded in NVivo and triangulated between two researchers. The article respects the consolidated criteria for reporting qualitative research guidelines.

Results: Three phases in the patients' clinical pathway to diagnosis and 12 barriers were found: Phase 1 (symptoms before consultation; n=4), lack of COPD knowledge, symptom denial, fear of lung cancer, and delayed general practice consultations; Phase 2 (primary care; n=3), letting bronchitis become chronic, priority to diseases with similar symptoms and/or more serious diseases, lack of COPD screening devices, time and curative treatments; Phase 3 (specialised medicine; n=5), treatment before diagnosis, late referral to pulmonologists, difficulty in accessing specialists and examination results, patient's reluctance to undergo further examinations, and need for additional tests to confirm a diagnosis.

Conclusion: People unaware of their COPD condition can encounter up to 12 barriers, which may combine before obtaining a formal diagnosis. Patients, GPs, pulmonologists and the state health authorities share responsibility for addressing these barriers and enhancing the care pathway.

Keywords: COPD Pathology; Physical Examination; Pulmonary Disease, Chronic Obstructive.

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Conflict of interest statement

Competing interests: GR was compensated for the analysis of the data and its valorisation. ES, MD, LF, CN, AO and MP do not report conflicts of interest. MD reports personal fees from GSK during the conduct of this work and from Air Liquide Medical Systems, Breas Medical AB and ResMed SAS, and non-financial support from L3 Medical, ISIS Medical and SOS Oxygene, outside of the submitted work. MZ reports grants and honoraria from Boehringer Ingelheim, fees from Novartis, Chiesi, CSLBehring, Menarini, Sanofi, AVAD and GSK outside of this study. OLR reports non-financial fees and benefits from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GlaxoSmithKline, MSD France, Vertex and VitalAire. OLR is the principal investigator of studies for Vertex and CSL Behring outside of this study.

Figures

Figure 1
Figure 1. Thematic diagram.
See this image and copyright information in PMC

References

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