Case finding for chronic obstructive pulmonary disease in primary care: a pilot randomised controlled trial

Haroon, Shamil; Adab, Peymané; Griffin, Carl; Jordan, Rachel

doi:10.3399/bjgp13x660788

Cited by 21 publications

(27 citation statements)

References 26 publications

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“…2,4,6,7 Similar studies, 9,10 reporting results for other countries, have found a significant relationship between the PYU and dyspnea in the presence of alterations in the spirometry. Therefore, based only on our study, we cannot state the significance of these particular findings.…”

supporting

confidence: 55%

Characterizing a population of smokers: An observational, transversal, non-randomized pilot study based on smoking history and spirometry changes

Reis¹,

Alves²,

Silva³

et al. 2015

Revista Portuguesa de Pneumologia (English Edition)

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supporting

confidence: 55%

Characterizing a population of smokers: An observational, transversal, non-randomized pilot study based on smoking history and spirometry changes

Reis¹,

Alves²,

Silva³

et al. 2015

Revista Portuguesa de Pneumologia (English Edition)

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“…The response rate in our opportunistic arm was lower than we expected from our model 4 but similar to our pilot study 21 (13% on average across the practices and a maximum of 31%).…”

mentioning

confidence: 74%

“…11 In the literature there have also been many uncontrolled evaluations of case finding approaches for COPD with similar yields to our casefinding arm. 10 However, other than our pilot study, 21 our trial is the first to evaluate the most costeffective method of administering an initial screening questionnaire, and to compare the results with routine care. The findings from this trial also confirm the results from our published model, 4 which suggested the likely superiority of active over opportunistic case finding.…”

mentioning

confidence: 99%

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Jordan

Adab

Sitch

et al. 2016

The Lancet Respiratory Medicine

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Word count: 4222 3 RESEARCH IN CONTEXT Evidence before this studyIt is widely accepted that COPD is substantially under-diagnosed worldwide. Mass population screening with spirometry is not recommended although early identification of undiagnosed patients with clinical disease is generally supported because COPD has significant patient, healthcare and societal burden which could potentially be lessened through timely diagnosis. A comprehensive systematic review of the effectiveness of case-finding studies, published in 2015, revealed 39 published studies but few included a comparator arm. Only one RCT has compared a case-finding approach with routine care to identify clinically significant COPD, identifying that opportunistic administration of a screening questionnaire at practice visits was twice as effective as routine care, but non-comparative studies suggest that high yields could be achieved from active case finding with mailed questionnaires to high risk patients. No previous trial has compared the clinical and costeffectiveness of alternative approaches to case-finding in a real-life primary care setting. Added value of this studyTargetCOPD is the first randomised controlled trial to evaluate the effectiveness and costeffectiveness of active case-finding for COPD compared with opportunistic case finding and to compare these approaches with routine care. Among 54 general practices, we found that when targeting ever smokers aged 40-79 years, active case finding was more than twice as effective as opportunistic case finding, and that together, these targeted approaches were over seven times as effective as current routine care. Active case finding was also more cost-effective than opportunistic case finding. Implications of all the available evidenceIn a real-life setting, active case-finding comprising an initial mailed questionnaire followed by spirometry should be recommended for identifying undiagnosed COPD in primary care. An important proportion of these previously undiagnosed patients have significant breathlessness and earlier identification and management with effective treatments including inhalers and pulmonary rehabilitation has the potential to improve their health. This trial provides the evidence for guidelines which was previously lacking. 4 SUMMARY Background

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“…We also performed PFT only for the participants who were suspected to be at high risk for COPD. Furthermore, data from Haroon et al are instructive, as they compared the yield and cost-effectiveness of two COPD case-finding approaches for ever-smokers aged 35–79 years with no history of COPD or asthma in primary care 23. They reported that respiratory questionnaires were posted to patients in the “targeted” arm and provided to patients in the “opportunistic” arm at routine general practitioner appointments.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of chronic obstructive pulmonary disease in high-risk individuals by using regional lung cancer mass screening

Sekine¹,

Yanagibori²,

Suzuki³

et al. 2014

COPD

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Background and objectivePatients with chronic obstructive pulmonary disease (COPD) are at risk for lung cancer; the diseases have common etiologies, including cigarette smoking. We aimed to clarify the effectiveness of COPD detection using a regional mass-screening program for lung cancer.Materials and methodsA total of 7,067 residents of Togane, Chiba, Japan received lung cancer screening between May and July, 2011. We defined four groups of possible COPD candidates: group A (n=358), positive smoking history, positive chronic respiratory symptoms; group B (n=766), positive smoking history, positive lifestyle-related disease; group C (n=75), passive smoking history, positive chronic respiratory symptoms; and group D (n=301), passive smoking history, positive lifestyle-related disease. Candidates underwent on-site pulmonary function testing (PFT).ResultsThe criteria for COPD candidates were fulfilled in 1,686 of 7,067 individuals (23.9%); 1,500 participants underwent PFT (89%), and 171 (11.4%) were diagnosed with COPD. The overall COPD detection rate was 2.4%. The frequency of COPD was significantly higher in groups A and B than in groups C and D (P=0.048); however, the distribution of COPD grades was similar among the groups (P=0.372). Multiple logistic regression analysis identified male sex, age 60 years or greater, and positive smoking history as risk factors for COPD.ConclusionCOPD screening using a community-based lung cancer-screening program may be effective for disease detection. Individuals who are 60 years of age or older with a positive smoking history should undergo PFT to detect COPD.

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Case finding for chronic obstructive pulmonary disease in primary care: a pilot randomised controlled trial

Cited by 21 publications

References 26 publications

Characterizing a population of smokers: An observational, transversal, non-randomized pilot study based on smoking history and spirometry changes

Characterizing a population of smokers: An observational, transversal, non-randomized pilot study based on smoking history and spirometry changes

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Surveillance of chronic obstructive pulmonary disease in high-risk individuals by using regional lung cancer mass screening

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