COPD screening efforts in primary care: what is the yield?

Tinkelman, David G.; Price, David; Nordyke, Robert J.; Halbert, Ronald J.

doi:10.3132/pcrj.2007.00009

Cited by 98 publications

(106 citation statements)

References 38 publications

(38 reference statements)

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“…(6) They also drew attention to the probable reasons for the underdiagnosis of COPD, stating that physicians are not fully aware of the importance of risk factors for and symptoms of COPD, and that they lack knowledge of the spirometric criteria for the disease. In addition, the authors stated that patients seek medical attention only when the symptoms affect their quality of life.…”

Section: Discussionmentioning

confidence: 99%

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

2012

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Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV 1 and FEV 1 /FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions:The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.Keywords: Pulmonary disease, chronic obstructive/diagnosis; Primary health care; Spirometry. ResumoObjetivo: Estimar a prevalência de DPOC não diagnosticada entre indivíduos com fatores de risco para a doença atendidos em unidades básicas de saúde (UBS) na cidade de Aparecida de Goiânia (GO). Métodos: Os critérios de inclusão foram ter idade ≥ 40 anos, ter história de tabagismo > 20 maços-ano ou de exposição à queima de biomassa > 80 horas-ano e procurar atendimento médico em uma das UBS selecionadas. Todos os indivíduos incluídos no estudo foram submetidos a espirometria para a definição diagnóstica de DPOC. Resultados: Foram avaliados com sucesso 200 indivíduos, a maioria do sexo masculino. A média de idade foi de 65,9 ± 10,5 anos. Tiveram confirmação diagnóstica de DPOC 63 indivíduos. Desses, apenas 18 haviam sido previamente diagnosticados com DPOC (taxa de subdiagnóstico de 71,4%). Não houve diferenças significantes entre os subgrupos com e sem diagnóstico prévio de DPOC em relação a fatores demográficos e fatores de risco. Entretanto, houve diferenças significantes entre esses subgrupos em relação à presença de expectoração, chiado e dispneia (p = 0,047, p = 0,005 e p = 0,047, respectivamente). Os valores de VEF 1 e VEF 1 /CVF, em percentual do previsto, foram significativamente menores nos indivíduos com diagnóstico prévio de DPOC. A DPOC foi predominantemente leve a moderada em ambos os subgrupos. Conclusões: A taxa de subdiagnóstico da DPOC foi alta nas UBS estudadas. Um terço dos...

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Section: Discussionmentioning

confidence: 99%

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

2012

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“…COPD remains significantly under-diagnosed, 12 with diagnosis commonly missed or delayed until disease is advanced. A growing body of evidence suggests that early detection of airflow limitation and intervention for smoking cessation can delay lung function decline, reduce the burden of COPD symptoms, and improve patients' quality of life.…”

Section: Copd Case-identificationmentioning

confidence: 99%

“…A growing body of evidence suggests that early detection of airflow limitation and intervention for smoking cessation can delay lung function decline, reduce the burden of COPD symptoms, and improve patients' quality of life. [12][13][14] Therefore, widespread screening would have the potential to detect the disease at an early stage and improve outcomes through smoking cessation and other proven interventions. 1,6,13 However, at present there is insufficient evidence to recommend mass spirometry screening for asymptomatic people.…”

Section: Copd Case-identificationmentioning

confidence: 99%

“…[15][16][17] Targeted, systematic case-identification in primary care has been proposed as a strategy to improve diagnosis rates and enable early detection and management, including aggressive smoking cessation efforts. 12,18,19 Primary care encounters also enable opportunistic preliminary assessment of people who present with respiratory symptoms and risk factors such as smoking. The IPCRG currently recommends that all patients over 35 years old should be evaluated for their risks of developing COPD (see Figure 1), either by taking a history using validated screening questionnaires based on a combination of risk factors and symptoms (see Table 1), 20 'case-identification' spirometry as described below, or standard diagnostic spirometry.…”

Section: Copd Case-identificationmentioning

confidence: 99%

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Spirometry in primary care case-identification, diagnosis and management of COPD

Price

Crockett

Arne

et al. 2009

Primary Care Respiratory Journal

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SummaryChronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide, yet it remains significantly under-diagnosed. Systematic and opportunistic case-identification efforts in primary care, using questionnaires, careful assessment to identify symptoms, and follow-up spirometry, might improve diagnosis rates and enable earlier detection and management of COPD.The aims of spirometry performed for case-identification purposes are to exclude those patients with symptoms but normal lung function and identify those who require more complete investigation for COPD, including 'diagnostic standard' spirometry. Among patients with a confirmed diagnosis of COPD, spirometry monitoring is useful in identifying those with rapid deterioration in lung function who require further assessment. Spirometry in primary care can also support patient education and may encourage smoking cessation and treatment adherence.

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“…12 The COPD case-finding program instigated screening high-risk patients at the indigent care clinic with the COPD Questionnaire and conducted pre-post bronchodilator challenge spirometry to confirm COPD Questionnaire findings. For patients with spirometry indicative of COPD, the GOLD guidelines were used to stage the level of COPD (i.e.…”

Section: Introductionmentioning

confidence: 99%

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program

Estes

Short

Bowser³

et al. 2014

Chron Respir Dis

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Chronic obstructive pulmonary disease (COPD) is a persistent progressive respiratory disease that is increasing in prevalence and cost in the United States health care system. Delays in recognition, diagnosis, and treatment are associated with poorer clinical outcomes. These delays are seen more often in populations experiencing economic hardship, lack of access to care, and lack of insurance, such as those seen in an indigent care clinic. The COPD case-finding program was planned as an evidence-based quality improvement project with a prospective, descriptive design generating a convenience sample of patients meeting modified screening criteria (i.e. patients 40 years of age with a smoking history and no pulmonary disease history) in a community-based indigent care clinic which was not screening for COPD. Practice change recommendations were guided by the Diffusion of Innovations Model. Descriptive statistics were used to describe the sample (i.e. age, ethnicity, race, gender, income, and selected comorbidities). Sensitivity, specificity, positive predictive value, negative predictive value, prevalence, and receiver operator characteristics curve COPD Questionnaire were calculated for this sample.

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COPD screening efforts in primary care: what is the yield?

Cited by 98 publications

References 38 publications

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Spirometry in primary care case-identification, diagnosis and management of COPD

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program

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