Screening and case finding

Our knowledge of COPD has widely expanded after decades of intensive clinical research. However, there remain many controversies surrounding when, where, by whom and for whom COPD screening and case finding with spirometry and other tools should be conducted, and often recommendations are not evidence based. Is a case like that described above worth further exploration? If it is confirmed, why was a signal of airflow limitation not picked up in previous annual check-ups (figure 1)? When does such an active worker (and sportsman) become a patient? And would you rule out asthma or ACOS? Meanwhile, COPD remains significantly underdiagnosed, with diagnosis commonly missed or delayed until the condition is advanced. It is envisaged that early diagnosis of COPD should have an impact on individual and population outcomes, but definitive confirmation proves elusive. Despite significant effort and investment, the implementation of quality spirometry is limited because of a number of hurdles and limitations, some of which are described in this chapter. The routine use of spirometry in primary care in all patients with respiratory symptoms should reduce COPD underdiagnosis.