Do family physicians' records fit guideline diagnosed COPD?

Albers, Mieke; Schermer, Tjard; Molema, Johan; Kloek, Carien; Akkermans, Reinier; Heijdra, Yvonne F.; Weel, Chris van

doi:10.1093/fampra/cmp005

Cited by 29 publications

(33 citation statements)

References 29 publications

(27 reference statements)

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“…In effect, underdiagnosis has been shown in earlier epidemiological studies of COPD among primary care patients [9,11,31]. These studies have shown that underdiagnosis of COPD occured partly because of "doctor's delay", i.e., doctors who don't suspect underlying COPD [32,33] and partly because of "patient's delay", i.e, patients who self-report good health [34]. …”

Section: Discussionmentioning

confidence: 99%

The prevalence of undiagnosed chronic obstructive pulmonary disease in a primary care population with respiratory tract infections - a case finding study

et al. 2011

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BackgroundChronic obstructive pulmonary disease (COPD) is an underdiagnosed cause of morbidity and mortality worldwide. Prevalence of COPD has been shown to be highly associated with positive smoking history and increasing age. Spirometry is the method used for diagnosing COPD. However, identifying patients at risk of COPD to undergo spirometry tests has been challenging. Therefore, there is a need for new cost-effective and feasible diagnostic screening procedures for use in primary care centers. Our aim was to describe the prevalence and severity of undiagnosed COPD in a group of patients with respiratory infections attending urgent primary care, and to identify those variables in patients' history that could be used to detect the disease.MethodsPatients of 40-75 years (n = 138) attending urgent primary care center with acute respiratory tract infection, positive smoking history and no previously known pulmonary disease underwent pre- and post bronchodilator spirometry testing four to five weeks after the acute infection. Prevalence and severity of COPD were estimated following the Global Initiative for COPD (GOLD) criteria. Variables such as sex, age, current smoking status, smoking intensity (pack years) and type of infection diagnosis were assessed for possible associations with COPD.ResultsThe prevalence of previously undiagnosed COPD in our study group was 27%, of which 45% were in stage 1 (FEV1 ≥ 80% of predicted), 53% in stage 2 (50 ≤ FEV1 < 80% of predicted), 3% in stage 3 (30 ≤ FEV1 < 50% of predicted) and 0% in stage 4 (FEV1 < 30% of predicted). We found a significant association between COPD and age ≥ 55 (OR = 10.9 [95% CI 3.8-30.1]) and between COPD and smoking intensity (pack years > 20) (OR = 3.2 [95% CI 1.2-8.5]). Sex, current smoking status and type of infection diagnosis were not shown to be significantly associated with COPD.ConclusionA middle-aged or older patient with any type of common respiratory tract infection, positive smoking history and no previously known pulmonary disease has an increased likelihood of having underlying COPD. These patients should be offered spirometry testing for diagnosis of COPD.

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Section: Discussionmentioning

confidence: 99%

The prevalence of undiagnosed chronic obstructive pulmonary disease in a primary care population with respiratory tract infections - a case finding study

et al. 2011

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“…3 Physicians often have a low index of suspicion of COPD, especially in women and midlife patients. [4][5][6] Heterogeneity in clinical presentation of COPD compounds the challenge for primary care; COPD comprises multiple phenotypes, affecting the disease pathology (eg, chronic bronchitis, Primary Care Strategies for COPD emphysema, or airways disease) and its natural history (frequent exacerbations, pulmonary cachexia, exercise intolerance, or hyperresponsive airways). 7 Among patients referred to pulmonary practices, the time lag between initial primary care presentation and definitive COPD diagnosis averages 7 to 15 years-a period of increasing symptoms, declining activity, risk of exacerbations, and perceptibly worsening health-related quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…7 Among patients referred to pulmonary practices, the time lag between initial primary care presentation and definitive COPD diagnosis averages 7 to 15 years-a period of increasing symptoms, declining activity, risk of exacerbations, and perceptibly worsening health-related quality of life. 4,6 Once recognized, COPD may still be inadequately treated due to health care providers' therapeutic pessimism. 5 When COPD treatment is undertaken, it often falls prey to systemic preoccupation with acute care.…”

Section: Introductionmentioning

confidence: 99%

Innovations to Achieve Excellence in COPD Diagnosis and Treatment in Primary Care

Fromer

Barnes

Garvey

et al. 2010

Postgraduate Medicine

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Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. Proactive diagnosis and evidence-based management can alleviate the impact of COPD on patients' lives. Smoking cessation has been proven to slow the rate of lung function decline. Maintenance pharmacotherapy and immunizations reduce exacerbations. Pulmonary rehabilitation improves respiratory symptoms and physical functioning and reduces rehospitalizations after exacerbations. Self-management education improves health-related quality of life and reduces inpatient and emergency care usage. Maintenance treatment with long-acting inhaled bronchodilators is appropriate beginning in moderate COPD to maintain airway patency and reduce exacerbations. Tiotropium is US Food and Drug Administration (FDA) approved to treat bronchospasm and reduce exacerbations in patients with COPD; salmeterol/fluticasone is FDA approved to treat airflow obstruction in COPD and reduce exacerbations in patients with a history of exacerbations. Other maintenance long-acting bronchodilators-salmeterol, formoterol, and budesonide/formoterol-are FDA approved to treat airway obstruction in COPD but lack an approved indication against exacerbations. FDA warnings on the use of long-acting beta-adrenergic agents (LABAs) in asthma specifically exempt COPD and do not apply to LABA/inhaled corticosteroid combinations used in COPD. The actual effectiveness achieved in practice with any COPD therapies depends on patients' inhaler technique, adherence, and persistence. Medication usage rates and inhaler proficiency may be improved by concordance, in which the health care provider and patient collaborate to make treatment plans sustainable in the patient's daily life. Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease.

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“…All these documents give recommendations on how to improve the diagnosis and treatment of COPD patients and to control the costs of this disease. However, there are many proofs that guideline recommendations for management of COPD are not adequately followed in clinical practice both by GPs [27] and also by some respiratory specialists especially in relation to treatment [28,29]. In particular, the observed prevalence of COPD in records of GPs is notably lower than would be expected according to what found using health questionnaires and specific studies [30] and this means that a great part of patients are not diagnosed and consequently not treated.…”

Section: Introductionmentioning

confidence: 99%

Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education

Sanguinetti¹,

Benedetto

Donner

et al. 2014

Multidiscip Respir Med

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BackgroundSymptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease.MethodsPneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients’ phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented.Results1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country and practiced their profession both in public and private hospitals and in territorial sanitary facilities. GPs were 1,330 males (71.35%) and 534 females (28.64%), mean age 56,29 years (range 27-70 yrs). Mean duration of general practice was 25.56 years (range: 0,5-40 yrs) with a mean of 1,302.43 patients assisted by each GP and 2,427,741 patients assisted in all. The majority of GPs affirmed that in their patients COPD has a mean-to-great prevalence and a mean/high impact on their practice, preceded only by diabetes and heart failure. Three-quarters of GPs refer to COPD guidelines and most of them believe that a screening on their assisted patients at risk would enhance early diagnosis of COPD. Tobacco smoking is the main recognized cause of COPD but the actions carried out by GPs to help a patient to give up smoking result still insufficient. The majority of GPs recognize spirometry as necessary to early COPD diagnosis, but the main obstacle pointed out to its wider use was the too long time for the spirometry to be performed. GPs’...

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Do family physicians' records fit guideline diagnosed COPD?

Cited by 29 publications

References 29 publications

The prevalence of undiagnosed chronic obstructive pulmonary disease in a primary care population with respiratory tract infections - a case finding study

The prevalence of undiagnosed chronic obstructive pulmonary disease in a primary care population with respiratory tract infections - a case finding study

Innovations to Achieve Excellence in COPD Diagnosis and Treatment in Primary Care

Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education

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