Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

TY - JOUR

T1 - Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

AU - Løkke, Anders

AU - Ulrik, Charlotte Suppli

AU - Dahl, Ronald

AU - Plauborg, Liane

AU - Dollerup, Jens

AU - Kristiansen, Luise Cederkvist

AU - Cording, Patrick Hagge

AU - Dehlendorff, Christian

AU - TOP GOLD study-group

PY - 2012/8

Y1 - 2012/8

N2 - Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n 241) recruited subjects with no previous diagnosis of lung disease, >35 yrs, and at least one respiratory symptom. Age, smoking status, pack-years, BMI, dyspnoea score (MRC), and pre-bronchodilator spirometry data was obtained. Subjects with airway obstruction (FEV1/FVC ≤ 0.7) at initial spirometry were tested for reversibility, according to Danish COPD guidelines, with bronchodilator and, if necessary, corticosteroids in order to confirm a diagnosis of COPD. Results: A total of 4.049 (49 females) subjects were included; mean age 58 yrs, BMI 27, and 32 pack-years. The COPD prevalence was 21.7; 8.3 in subjects younger than 48 years. Most patients were classified in GOLD stages I and II (36 and 50, respectively). The number needed to screen (NNS) for a new diagnosis of COPD was 4.6. COPD diagnosis was related to gender, age, BMI (p < 0.001), pack-years, and cough (p < 0.001), wheezing (p < 0.001) and sputum production (p 0.002). A threshold of 10 pre-test risk of COPD would have reduced the number of spirometry tests by 35 although 90 of the patients with COPD would still have been identified (NNS 3.9). Conclusions: Of the at-risk subjects studied, 22 were diagnosed with COPD. A case-finding strategy providing questionnaire assessment and diagnostic spirometry to high-risk subjects in primary care, and therefore, identifies a large proportion of undiagnosed COPD patients, especially in the early stages of the disease.

AB - Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n 241) recruited subjects with no previous diagnosis of lung disease, >35 yrs, and at least one respiratory symptom. Age, smoking status, pack-years, BMI, dyspnoea score (MRC), and pre-bronchodilator spirometry data was obtained. Subjects with airway obstruction (FEV1/FVC ≤ 0.7) at initial spirometry were tested for reversibility, according to Danish COPD guidelines, with bronchodilator and, if necessary, corticosteroids in order to confirm a diagnosis of COPD. Results: A total of 4.049 (49 females) subjects were included; mean age 58 yrs, BMI 27, and 32 pack-years. The COPD prevalence was 21.7; 8.3 in subjects younger than 48 years. Most patients were classified in GOLD stages I and II (36 and 50, respectively). The number needed to screen (NNS) for a new diagnosis of COPD was 4.6. COPD diagnosis was related to gender, age, BMI (p < 0.001), pack-years, and cough (p < 0.001), wheezing (p < 0.001) and sputum production (p 0.002). A threshold of 10 pre-test risk of COPD would have reduced the number of spirometry tests by 35 although 90 of the patients with COPD would still have been identified (NNS 3.9). Conclusions: Of the at-risk subjects studied, 22 were diagnosed with COPD. A case-finding strategy providing questionnaire assessment and diagnostic spirometry to high-risk subjects in primary care, and therefore, identifies a large proportion of undiagnosed COPD patients, especially in the early stages of the disease.

U2 - 10.3109/15412555.2012.685118

DO - 10.3109/15412555.2012.685118

M3 - Journal article

C2 - 22643016

SN - 1541-2555

VL - 9

SP - 458

EP - 465

JO - COPD: Journal of Chronic Obstructive Pulmonary Disease

JF - COPD: Journal of Chronic Obstructive Pulmonary Disease

IS - 5

ER -