Journal article
Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice
Aarhus University1
Copenhagen University Hospital Herlev and Gentofte2
Boehringer Ingelheim Danmark A/S3
Pfizer ApS4
Department of Informatics and Mathematical Modeling, Technical University of Denmark5
Mathematical Statistics, Department of Informatics and Mathematical Modeling, Technical University of Denmark6
Algorithms and Logic, Department of Informatics and Mathematical Modeling, Technical University of Denmark7
DTU Data Analysis, Department of Informatics and Mathematical Modeling, Technical University of Denmark8
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.
Language: | English |
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Publisher: | Taylor & Francis |
Year: | 2012 |
Pages: | 458-465 |
ISSN: | 15412563 and 15412555 |
Types: | Journal article |
DOI: | 10.3109/15412555.2012.685118 |