Abstract
Background and aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify early stages of COPD in a high-risk population identified through general practice.
Methods: Participating GPs (n=241) recruited subjects with no previous diagnosis of obstructive lung disease, > 35 yrs, and at least one respiratory symptom. Age, smoking status, pack-years, BMI, dyspnoea score (MRC), and pre- and post-bronchodilator spirometry data was obtained.
Results: A total of 4.049 (49% females) subjects were included; mean age 58 yrs, BMI 27, and 32 pack-years. The COPD prevalence in our population 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: A case-finding strategy providing screening and diagnostic spirometry to high-risk subjects in primary care identifies a large proportion of undiagnosed COPD patients, especially in the early stages of the disease.
- © 2011 ERS