Prevalence, severity and underdiagnosis of COPD in the primary care setting

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a common disease with a steadily increasing prevalence and mortality. However, recent epidemiological estimates differ depending on the population studied and methods used. Aim: To investigate the prevalence, severity and burden of COPD in a primary care setting. Methods: From 4730 patients registered in a single primary care practice, all 2250 patients aged 40 years or more were invited to participate. Participants completed a questionnaire on smoking, respiratory symptoms, education and social status. A physical examination was followed by pre-and post-bronchodilator (BD) spirometry. Results: Of the eligible patients, 1960 (87%) participated. 92% of spirometric tests met the ATS criteria. Airflow limitation was demonstrated in 299 (15%) of the participants pre-BD and in 211 (11%) post-BD. COPD was diagnosed in 183 patients (9.3%). Of these patients, the degree of post-BD airflow limitation was mild in 30.6%, moderate in 51.4%, severe in 15.3% and very severe in 2.7%. Only 18.6% of these patients had previously been diagnosed with COPD; almost all of these had severe or very severe airflow limitation. As a result of the study, a diagnosis of asthma was made in 122 patients. Conclusions: The prevalence and underdiagnosis of COPD in adult patients in this primary care setting made case finding worthwhile. Large numbers of newly detected patients were symptomatic and needed treatment. Limiting investigations to smokers would have reduced the number of COPD diagnoses by 26%.

A combination of the IPAG questionnaire and PiKo-6® flow meter is a valuable screening tool for COPD in the primary care setting

“…8 There has been increasing interest during the last decade in the early diagnosis of COPD in the primary care setting as general practitioners (GPs) rather than pulmonary specialists make the initial diagnose and treat patients with respiratory symptoms. 9,10 The widespread application of spirometry by GPs 11,12 as well as by visiting trained nurses 13 may enhance the early diagnosis of COPD. On the other hand, in a multicentre randomised trial of the feasibility of performing spirometry in the GP surgery and the improvement in COPD/asthma diagnosis compared with conventional evaluation, only 104 out of 570 GPs agreed to participate in the spirometry group while the enrollment rate was remarkably low.…”

Geriatric dyspnea: Doing worse, feeling better

“…Obstructive Pulmonary Disease (COPD) with about one third of older individuals with clinically relevant airflow limitation not reporting any symptoms (Bednarek, et al, 2008). Only 9.4% to 22% of older individuals with clinically relevant airflow limitations are diagnosed with COPD and treated (Bednarek et al, 2008;Pena et al, 2000).…”

“…Only 9.4% to 22% of older individuals with clinically relevant airflow limitations are diagnosed with COPD and treated (Bednarek et al, 2008;Pena et al, 2000). Also in older patients with asthma, airflow restrictions are often poorly perceived and not optimally treated (de Vries & Petermann, 2008;Parameswaran et al, 1998).…”

“…Also in older patients with asthma, airflow restrictions are often poorly perceived and not optimally treated (de Vries & Petermann, 2008;Parameswaran et al, 1998). In COPD and asthma, under-reporting, late diagnosis or misdiagnosis, and poor treatment are related to mortality (de Vries & Petermann, 2008;Bednarek, et al, 2008).…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…27,154 Guidelines base the classification of severity on postbronchodilator spirometry, and recommend a threshold forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio less than 0.7 to confirm a diagnosis of COPD. [143][144][145][146][147][148] This fixed ratio cutoff has the advantage of simplicity but does not allow for the natural reduction in the ratio due to lung ageing, thus risking under-diagnosis in younger patients and over-diagnosis in the elderly.…”