Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

Abstract

Objective Early diagnosis is a key factor in the management of chronic obstructive pulmonary disease (COPD). Although mass screening is widely used, little is known about its accuracy and efficacy. This study investigated whether using spirometry during mass screening to detect COPD among community residents might be ineffective because of variability in the training and experience of examiners. Participants and Methods Both spirometry and a self-written questionnaire-based survey, including questions designed to detect respiratory symptoms, were conducted on community residents. Two separate studies were conducted on islanders living in similar environments. Study I was performed from 2004 to 2007 on Hachijyo Island residents, while study II, with a similar study design, was performed in 2003 on Inno Island residents. Results In study I, 3,592 subjects underwent examination over the 4-year study period; of these, 378 subjects underwent repeated examinations. Approximately 25% of the subjects had respiratory symptoms. Acceptable spirometry recordings were obtained for 62.0% (2004) to 84.1% (2006) of the subjects. In study II, 167 of the 254 subjects (65.7%) had respiratory symptoms. Acceptable assessment recordings were achieved in 254 subjects (95.5%). The suitability of the recordings was influenced by the extent/level of training of the examiners and the accompanying thoracic specialists. Conclusion We concluded that the effectiveness of health check-ups for COPD evaluation using spirometry was greatly influenced by the quality of the examiners, even when the subjects had respiratory symptoms. Thus, we recommend caution when screening for early signs of COPD during health check-ups.

Effect of a Chronic Obstructive Pulmonary Disease (COPD) Intervention on COPD Awareness in a Regional City in Japan

“…[8][9][10][11][12][13][14][15][16][17][18][19].7% of the population, with an increasing prevalence in association with increasing cigarette consumption and age (7)(8)(9). It is possible to prevent the progression of COPD with early diagnosis and effective treatment (1,(9)(10)(11). Smoking cessation is the most effective means of preventing COPD (1), and it is important to educate smokers as well as other members of the general public, as both passive smoking and air pollution are risk factors for COPD (1).…”

“…Symptoms occurring early in the disease trajectory, specifically breathlessness on exertion, are often overlooked by the individual and attributed to the normal aging process or thought to be the result of being unfit. For this reason, people with early signs of COPD often fail to seek medical attention and thus do not receive appropriate treatment in the early stages of the disease (10)(11)(12)(13). Furthermore, although cigarette packages carry warnings of the risk of lung cancer and COPD, data suggest that COPD awareness is lower among people with a history of smoking, particularly current smokers, compared with non-smokers (14,15).…”