COPD screening efforts in primary care

What is the yield?

David G. Tinkelman, David Brendan Price, Robert J. Nordyke, Ronald J. Halbert

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

INTRODUCTION: Underdiagnosis of COPD appears to be common, although the degree of underdiagnosis is rarely measured. To document the extent of underdiagnosis in a high risk group of ambulatory patients, we performed spirometry in smokers aged 40 years and over drawn from general practices in two countries. METHODS: Subjects were recruited from primary care practices in Aberdeen, Scotland, and Denver, Colorado, via random mailing. Current and former smokers aged 40 or older with no prior diagnosis of chronic obstructive respiratory disease (and no respiratory medications within the past year) were enrolled. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined as post-bronchodilator FEV1/FVC <0.70. RESULTS Spirometric examination was complete in 818 patients, of whom 155 (18.9%) had a study diagnosis of COPD. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity criteria, the COPD was mild in 57.4%, moderate in 36.8%, and severe in 5.8%. No patients had very severe disease according to GOLD criteria. DISCUSSION: Screening of smokers over 40 in general practice may yield 10 - 20% undiagnosed COPD cases, with a substantial proportion of these having moderate to severe disease. Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.
Original languageEnglish
Pages (from-to)41-48
Number of pages8
JournalPrimary Care Respiratory Journal
Volume16
Issue number1
DOIs
Publication statusPublished - 1 Feb 2007

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Bronchodilator Agents
Spirometry
General Practice
Scotland
Smoking Cessation
Early Diagnosis
Quality of Life

Keywords

  • adult
  • aged
  • Colorado
  • diagnostic errors
  • early diagnosis
  • forced expiratory volume
  • humans
  • mass screening
  • middle aged
  • primary health care
  • pulmonary disease, chronic obstructive
  • Scotland
  • severity of illness index
  • smoking
  • spirometry

Cite this

COPD screening efforts in primary care : What is the yield? / Tinkelman, David G.; Price, David Brendan; Nordyke, Robert J.; Halbert, Ronald J.

In: Primary Care Respiratory Journal, Vol. 16, No. 1, 01.02.2007, p. 41-48.

Research output: Contribution to journalArticle

Tinkelman, David G. ; Price, David Brendan ; Nordyke, Robert J. ; Halbert, Ronald J. / COPD screening efforts in primary care : What is the yield?. In: Primary Care Respiratory Journal. 2007 ; Vol. 16, No. 1. pp. 41-48.
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abstract = "INTRODUCTION: Underdiagnosis of COPD appears to be common, although the degree of underdiagnosis is rarely measured. To document the extent of underdiagnosis in a high risk group of ambulatory patients, we performed spirometry in smokers aged 40 years and over drawn from general practices in two countries. METHODS: Subjects were recruited from primary care practices in Aberdeen, Scotland, and Denver, Colorado, via random mailing. Current and former smokers aged 40 or older with no prior diagnosis of chronic obstructive respiratory disease (and no respiratory medications within the past year) were enrolled. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined as post-bronchodilator FEV1/FVC <0.70. RESULTS Spirometric examination was complete in 818 patients, of whom 155 (18.9{\%}) had a study diagnosis of COPD. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity criteria, the COPD was mild in 57.4{\%}, moderate in 36.8{\%}, and severe in 5.8{\%}. No patients had very severe disease according to GOLD criteria. DISCUSSION: Screening of smokers over 40 in general practice may yield 10 - 20{\%} undiagnosed COPD cases, with a substantial proportion of these having moderate to severe disease. Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.",
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N2 - INTRODUCTION: Underdiagnosis of COPD appears to be common, although the degree of underdiagnosis is rarely measured. To document the extent of underdiagnosis in a high risk group of ambulatory patients, we performed spirometry in smokers aged 40 years and over drawn from general practices in two countries. METHODS: Subjects were recruited from primary care practices in Aberdeen, Scotland, and Denver, Colorado, via random mailing. Current and former smokers aged 40 or older with no prior diagnosis of chronic obstructive respiratory disease (and no respiratory medications within the past year) were enrolled. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined as post-bronchodilator FEV1/FVC <0.70. RESULTS Spirometric examination was complete in 818 patients, of whom 155 (18.9%) had a study diagnosis of COPD. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity criteria, the COPD was mild in 57.4%, moderate in 36.8%, and severe in 5.8%. No patients had very severe disease according to GOLD criteria. DISCUSSION: Screening of smokers over 40 in general practice may yield 10 - 20% undiagnosed COPD cases, with a substantial proportion of these having moderate to severe disease. Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.

AB - INTRODUCTION: Underdiagnosis of COPD appears to be common, although the degree of underdiagnosis is rarely measured. To document the extent of underdiagnosis in a high risk group of ambulatory patients, we performed spirometry in smokers aged 40 years and over drawn from general practices in two countries. METHODS: Subjects were recruited from primary care practices in Aberdeen, Scotland, and Denver, Colorado, via random mailing. Current and former smokers aged 40 or older with no prior diagnosis of chronic obstructive respiratory disease (and no respiratory medications within the past year) were enrolled. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined as post-bronchodilator FEV1/FVC <0.70. RESULTS Spirometric examination was complete in 818 patients, of whom 155 (18.9%) had a study diagnosis of COPD. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity criteria, the COPD was mild in 57.4%, moderate in 36.8%, and severe in 5.8%. No patients had very severe disease according to GOLD criteria. DISCUSSION: Screening of smokers over 40 in general practice may yield 10 - 20% undiagnosed COPD cases, with a substantial proportion of these having moderate to severe disease. Earlier diagnosis through targeted case-finding will allow early, aggressive smoking cessation efforts and may lead to a reduction in the burden of COPD symptoms and a reduced impact of the disease on health-related quality of life in these patients.

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